Martha writes:

Hello Dr. Griffin,

I love your podcasts! I have a question regarding age and Covid vaccine dose. Does it seem that the elderly population might need a larger dose of the vaccine than younger people? If so, do you know of any plans to test for this and perhaps adjust the vaccines in the future? 

Similarly, should younger people (young adults and/or children) perhaps get a smaller dose?

My (elderly) father has been asking about this and I would love to find out the current thinking about this for him.

Thank you!

Walter writes:

Hi Doc,  

Is there any known downside to any of the anti-SARS-CoV-2 spike protein vaccines for older kidney patients who do not yet require dialysis?   

I imagine vaccination produces at least some antibodies against the ACE2/spike protein complex.  That could engender cross reactivity against the ACE2 receptors themselves.  The heart, kidneys and lungs are rich in those receptors.  I noticed that kidney patients were not included in the original Pfizer/BioNTech or Moderna vaccine trials and have wondered why. 

Walt Baase 
IMB, University of Oregon

Thomas writes:

Greetings Daniel,

Can’t begin to tell you how much I and several of my colleagues enjoy listening to your updates!  We wish ALL our compatriots took the time to check out the great information TWIV provides.  Don’t know if you’ll have the time to answer this but I’ll fire it at you knowing you’d have a super sensible approach.

Our facilities are beginning to revisit policies for preoperative SARS-CoV-2 testing as well as reconsidering “wait times” in our OR’s after AGPs (aerosol generating procedures).  For roughly the last year, we have been testing all our elective surgical patients within 72 hours of their procedures and asking them to isolate following their testing until day of surgery to reduce both the risks associated with an infected patient coming to the hospital/surgery center and spreading SARS-CoV-2, and more importantly the risks of increased complications were a patient to have perioperative COVID-19.  Additionally, we have had various “wait times” after both intubation, extubation, or other aerosolizing procedures depending on air exchange rates in the OR’s.  The proposals are to:

1-Eliminate preop SARS-CoV-2 testing in fully vaccinated patients

2-Decrease or eliminate “wait times” after AGP’s if patients are either vaccinated or have tested negative prior to surgery

The latter certainly goes against our current practice since all elective cases for the last many months would have had negative preop tests and we currently DO wait for the requisite number of air exchanges prior to opening the rooms up.  The vast majority of the staff has been fully vaccinated since early to mid February so risks of serious disease in our staff shouldn’t really be the concern.  Since some facilities have 14 minute pre AND post waits, you can imagine efficiency isn’t what it was prepandemic.  Admittedly, item #1 goes against your mantra “Never miss an opportunity to test”, but I suspect the risks are at least markedly reduced.

Given the current CDC recommendations regarding travel for vaccinated people (i.e. they are still recommending against it), it sounds like data is still lacking to definitively say vaccinated individuals can’t transmit SARS-CoV-2 to other people.  Curious if you and your crew have any thoughts on these proposed changes?

Do you have any thoughts on if there is an ideal time to schedule a COVID-19 vaccination either before or after a planned elective surgery?

We have administrators on high proclaiming patients shouldn’t receive a COVID-19 vaccination for 14 days before or after a scheduled surgery.  I’ve heard surgeons proclaim “you could get a fever from the vaccine and it might mimic a surgical site infection” and similarly others have worried about side effects mimicking COVID-19 and leading to postponement of their procedures.  I tend to err on the side of “never miss an opportunity to vaccinate”!

Thanks for all you do!

Thomas A Gettelman, MD
Kaiser Permanente – CPMG Anesthesiology
Denver, CO