Mark writes:

Dear Dr. Griffin: 

I was just wondering if you have seen any cases of PAMM as a vascular stage sequela of SARS-COV2 infection in your practice? 



Chaim writes:

Hi Dr. Griffin,

With most indoor spaces rapidly moving to “masks optional,” what do I need to do to best keep my seven year old safe? Is his mask enough to protect him, at least for short exposures? What about longer exposures, like synagogue services? Should we just be keeping him away from all public indoor places (other than school?) for the rest of the year, until he can get vaccinated?



Alina writes:

Dear Dr. Griffin,

A question regarding a B-cell depleted Patient with multiple sclerosis in her 40s, last Infusion of Rituximab in February 2021. First dose of Pfizer vaccine in April, second dose of Pfizer 3 weeks later. In May some B-cells were detectable (<=0,5%). Because of a former medication there is a T-cell deficiency (T-cell responses are going to be tested anyway), as well as Lymphopenia. She was tested for antibodies 3 weeks after the second vaccine dose, there were none at all detectable (below detection limit (38) at Machine used). Another round of vaccine shots is going to be administered starting July (=2 ½ months after second dose, 5 ½ months after Rituximab) hopefully in time before the next round of Rituximab will be needed (usually with her at 8 months). Surgery because of a precancerous disease is at the moment being postponed until after vaccination, but has to happen in fall this year at the latest.

Question: What is to be done, if the second round of vaccines does not build an immune response? Could monoclonal antibodies be a temporary solution for her for prevention of Covid in high risk settings like during hospitalization where masking is not possible?

Here in Germany the monoclonals are not licensed for preventive use so there happens to be the practical problem of how to get hold of them, even as the patient is willing to pay for all medication/ import/ transportation. Any ideas are highly appreciated.

Thank you for all the helpful information provided via TWiV.

Yours, Alina

Jonathan writes:

I am an Internal Medicine Hospitalist who is getting revenge against the COVID19 by administering vaccines.

I have been heartened to see our clinics here in San Diego fill up with young adolescents for the Pfizer vaccine. However I am getting questions from parents about myocarditis in this population after the vaccine. It appears that the risk may be increased, and it appears that most cases are mild.

However it often helps to discuss these kinds of things in context- what is the underlying rate of myocarditis in this population? What is the relative risk of COVID infection vs myocarditis? What are long term effects or serious outcome percentages in kids who get this inflammatory state? I can see a parent, supportive of vaccinations, say “hmmm, the prevalence of virus where we live is very low now, so why risk having my kid get this vaccine related condition?”