Chris writes:

Dear Daniel,

The CDC is now saying that if someone has been fully vaccinated (allowing for 2 weeks after) they do not have to quarantine when directly exposed to someone with Covid. Then, can’t we assume that person is not expected to infect another person and would be able to visit/be indoors with others who are not vaccinated?! As an example, I am a fully vaccinated teacher but my students are not vaccinated. If I am exposed to one of them who comes down with Covid, the CDC is saying I can still teach in-person; which strongly implies I am not at significant risk of transferring Covid to other people.

My real motive is that I REALLY want to visit my infant grandson but neither of his parents are vaccinated, and won’t be any time soon. If I have to quarantine before I visit, what is the minimum amount of time to ensure a good amount of safety (again, I am fully vaccinated).

Thank you so much for all you and the TWIV team do!!!


Javad writes:

Hi Daniel and Vincent,

As a primary care physician who works in both the clinic and hospital and is faculty at both the med school and residency, I am disappointed at the lack of guidance there is for COVID management in Primary Care.  Where there is clear guidance for how to manage COVID patients in the hospital based on a fair amount of research, there is almost nothing for primary care doctors. 

I have been excited about the progress with Monoclonal Antibodies.  Unfortunately in practice these have been underutilized.  In our large system at the University of Minnesota, for instance, we have been able to use this treatment for only a half dozen or so patients per day (out of dozens who would qualify.)  This is due in part by bottlenecks in getting tests done and results back in a timely manner.  But the bigger issue has been in logistics of giving the treatment compounded by the financial issues of reimbursement.  Essentially the system makes zero money off of this and is already financially strapped therefore it simply isn’t happening to any real degree.  

Even though we have far more COVID in the community than in the hospital, basic questions of whether to use anticoagulation and/or aspirin have not been answered.  Therapeutics that are logistically more feasible are not known.  A small study showed Fluvoxamine could be a game-changer in terms of limiting hospitalization but a larger study is in its early stages.  What would you recommend in terms of outpatient management?  We are doing a lot of testing, and monitoring, but it would be nice to have better research and guidance as to what more can be done.  

Thanks for doing all you do.  Will be supporting TWIV and Parasites without Borders as a thank you!

Javad Keyhani MD
Assistant Professor of Family Medicine
University of Minnesota

William writes:

Is it safe to receive the covid vaccine if you are incubating Covid-19 or ill with Covid-19.


William A Hardman, M.D.

Stefan writes:

I just want to start off by Thanking you and everyone that contributes on TWIV for their service.  You are all heroes and your hard work and dedication will be remembered for many years to come. I stumbled upon the TWIV Channel and have found much comfort with the information and updates.  

I apologize for the long winded email. My question is on the last paragraph but if you needed the back story here it is… 

My mother was first diagnosed with COVID on March 24, 2020.  My mom’s journey with COVID has been quite tragic.   Back in late December 2019 my mother first started to experience symptoms of shortness of breath and chest discomfort.  Shortly after that she was diagnosed with Pneumonia.  After prescribing antibiotics my mothers condition did not improve and in late January and early February she was sent to a pulmonologist.  He ordered several chest X-rays and discovered some black spots on her lungs which were an area of concern.  They wanted to get a sample of the fluid from her lungs however, the earliest availability was in mid March.  Unfortunately COVID started to take off in New York and the procedure was delayed because all elective procedures were on hold .   Finally Mather Hospital in Port Jefferson , NY allowed my mother to be admitted for the procedure but had to perform a COVID test before performing the procedure.  Even though my mother was still complaining of chest pains, still suffering from pneumonia and constantly felt shortness of breath the hospital performed a PCR test and discharged until the results returned.  Test results came back positive on March 24 2020 and was advised to quarantine.  My mom and dad were staying in my home because they came to visit in the summer and my father was diagnosed with Leukemia. He had just finished his treatment in December and was waiting for my mom to recover so they can head home. Upon receiving news of her positive test my parents immediately left for Florida since I have a 3 yr old and 3 week old baby and they didn’t want the kids to get sick.

My parents made it to Florida and my moms condition seemed to be improving until late April about 4 weeks after she left NY. My mom couldn’t breathe and rushed to the hospital.   Following that admission she spent 16-17 weeks in the ICU and from the doctors account she’s only alive due to some miracle. She was nicknamed the miracle patient.   She  was on high flow oxygen and doctors and thankfully her Doctor refused to put her on a ventilator.   My mom then spent approx 4-6 weeks at 2 rehabilitation centers and was finally allowed to go home . However till this day she is still on O2 for 24 hrs a day and receiving PT several days a week.  My mom went into the hospital at 140lbs and was discharged weighing 80lbs.  

I’m writing  to you because I’m looking for your opinion.  I know you might not be able to answer my question but I figured why not try.   The doctors in Florida tell my mom that it’s safe for her to receive the vaccine but my mother is 74 years old and is very frail.  Since August she has gained 5lbs and is still suffering for PTSD, difficulty breathing and the loss of vision from 1 eye.  Based on her condition is it safe for her to get the MRNA vaccine or should she wait for the JJ Vaccine.  I have read reports of elderly frail seniors in Europe passing away subsequent to receiving the MRNA vaccine.   My concern is Florida does not follow a lot of the protocols for masking and social distancing.  I’m concerned about the variants and afraid my moms passive immunity will not be enough protection .  My sister doesn’t want my mom to be vaccinated and I am for vaccinations.  Right now my mom was advised that it is a 10 week wait for her vaccination.  Since the doctors in Florida don’t have the same level of experience dealing with COVID patients and the MRNA vaccine I’m looking for some sort of guidance. 

Thank you for al that you do and thank you for your time.

Warmest regards,