Dagfinn writes:

Dear Twivers!

Greetings from a sunny and freezing cold morning in Oslo, Norway @ -9.5˚C.

I have been watching the twivs sporadically (would have seen them systematically, but I’ve had quite an increased workload during the past year), and am delighted to follow your eloquent, entertaining and enlightening conversations. Also I’ve been inspired to acquire a copy of the 5th edition of “Principles of Virology” which was delivered to my door two days ago.

I have a question for you, regarding a group of patients who are frequently overlooked in the general medical discourse. I’ve been working with drug addicted patients for about twenty years. They are a challenging group of patient with very complex pathologies, spanning from psychiatry to infectious disease, with virtually all and any possible disease from any specialty in between them. As the pandemic broke out, I was quite convinced all hell was upon us, considering these patients’ often complete lack of hygienic considerations and poor immunological status – especially among the i.v. users.

Now, we’ve been relatively spared here in Ultima Thule, on the northern outskirts of Europe, considering our remote location and prompt actions from our government and health officials when the pandemic started. We bought some time by being situated rather far from the epicentres of the disease, and have experienced no more than slightly above 60.000 cases and about 550 deaths. However, we are still under harsh restrictions…

We’ve set up a few isolation wards dedicated to our drug addicted patients. I’ve been ordered to work in such facilities twice during the past year, and surprisingly, there are extremely few cases. Most of our admitted cases have been quarantines. There have been a few cases of confirmed disease. However, these patients – while having some sort of addiction problem – have not represented our typical addictees, but rather people with  problematic use of alcohol and prescription drugs. There have been very few of our regulars.

By report from LAR (our national service for maintenance and substitution therapy), not a single case among their patients have been reported. I see similar reports from other countries. There seems to be some mechanism in drug abusers that prevents them from being infected, not solely the fact that they are living partly separate from the rest of society, and don’t travel much. They still interact with health and social services, and they have friends and family, go to grocery stores and other public places and services.

Do any of you have ANY idea why this group of patients – who are usually very susceptible to infection – seems to be nearly unaffected by the SRS-CoV-2 virus?

Laura writes:

Is there any data about the various different COVID-19 vaccines ability to prevent long COVID?

As background: I am in vaccine priority group 2, so it seems likely that by the time I am able to be vaccinated, multiple vaccines will have been given an EUA.  The messaging I’ve heard in the news lately is: if you are offered a vaccine, take it–don’t be picky about the brand, all of them are extremely good at preventing hospitalization and death. However, I’m fortunate to be in a demographic where hospitalization and death are already extremely unlikely, so my primary concern has been long COVID (as a healthy 40 year old woman with a history of autoimmune disease).  Since studies have shown that even a relatively mild case of COVID can lead to long COVID, it seems to me that I would want to choose the vaccine that has the highest efficacy of preventing disease of any severity.

Thanks for your insight,


Aviva writes:

Discussions have started in our family about what is safe to do for Passover, as it’s only a month and a half away.  We usually get together with my husband’s family in NY – except for last year, when we were by ourselves because of the pandemic. We take it in turns to host. Due to religious restrictions we all stay over for 2 days, and this year, its their turn to host!  If we get together there will be 6 adults (ranging from 54 to 90), and 4 kids (some of whom are adults).  All the adults, and one of the adult kids, either because of age or profession will be vaccinated by then ( assume it is at least a week past 2nd vaccination). That leaves 3 kids – 12,16 and 21 who will not be vaccinated. Our kids are in school ( ages 12 and 16), but the schools have put in place a lot of mitigation, so that so far there has been no known in school transmission.  

Is it safe to get together for the first days of Passover, and the Seders? We can test the kids, we can keep them home from school for a few days before the festival, we can test them again.. but it would be so wonderful to be together for this festival. There is a debate in our family as to whether this is safe to do – and would value your input.

thank you 


Eugene writes:

Dear Dr Griffin,

I have greatly enjoyed listening to all your clinical updates.

My question is what your thoughts are on getting the mRNA Vaccine by people being immunosuppressed with diseases such as Crohn’s and treated with immunosuppressant  drugs like Stelara. 

I would imagine, not to miss the opportunity of getting the vaccine then perhaps resuming the immune drugs therapy  some time after the second vaccine dose.

Thank you

Atlanta, GA