John writes:
Thank you for your service. Microbe.tv has been an important part of my life.
I’m 71 years old. Due to colon cancer I’ve lost my spleen, pancreas, half of one lung and a couple of feet of colon. My health is not great, but my diabetes and blood pressure are well controlled. I received my second dose of the Moderna vaccine in February. Is there a test that I can request that will show the condition of my immune system? As of now, I don’t feel at all convinced that the vaccine has, or will, work for me as well as intended. A third dose is available, or soon will be. I will get one, if only for additional protection against infection (and, yes I do understand the difference between infection and disease). I REALLY don’t want the infection. I’m fairly certain that the disease would knock me off of my perch. I would really appreciate any information on available tests that would help me to understand my position.
Thank you,
John
Debbie writes:
Dr. Griffin,
I am an internist who has been educating the physicians in our medium sized primary care practice since the beginning of the pandemic. Your weekly updates have been so very very helpful in keeping us up to date and abreast of the rapidly changing literature. Thank you so very much.
As I look to the future of this virus becoming endemic, I’m trying to think how to frame this and what measures to follow. Obviously, it will have to become much less lethal or many more people will need to be vaccinated.
It occurs to me that hospital strain is one of the most important things to follow. In my home state of Texas, our non-medical governor has decided 15% of beds being occupied by Covid patients (was) a measure of distress. I can follow this number on the Johns Hopkins website for my state. Locally, it is harder to follow. It seems hospital strain numbers are not universally agreed upon and also seem to change. Hospitals are used to growing capacity during surges and emergencies. Is there any agreed upon and standardized measure of hospital strain? And if so, any reliable website for looking at it?
I’m also following the percent positive rate only as an indication of adequacy of testing and then looking at cases per 100,000 per 7 days on the CDC website or globalepidemics.org.
Additionally, home testing or very easily accessible testing is going to have to be a much bigger part of the solution moving forward. $20 for two tests is too expensive. Here in Texas, it is hard to find home tests, scheduled tests are 2 days out and turnaround times are increasing.
Debbie Cardell, MD
Jaime writes:
Good afternoon,
I know I speak for many clinicians when I give my sincere thanks for the last year and a half of ongoing updates on TWIV. I had been an occasional listener prior but have hardly missed an episode since the start of the sars cov 2 outbreak. I’m a primary care clinician-a family nurse practitioner of 19 years with a doctorate in translational research. The updates and links have assisted my protocol development team as we have been continuously evaluating the new data and making appropriate adjustments to help our patients and clinicians. At any rate-
Two clinical questions:
1.) We are in CA and have vaccine mandates for our public employee sectors. I had my first patient asking for a “medical excuse” from the mandate (which as of now can be a religious or medical excuse). The 30-something patient is currently undergoing infertility treatments and wants to wait until after she is either pregnant or gives birth to get the vaccine. Asked me to put in writing that there are no risks to pregnancy or fertility treatments which of course I cannot do. I discussed with her the risks of covid while being pregnant and asked her to talk to her reproductive health provider and come back in 2 weeks prior to the mandate’s effective date so we can make a determination while I do more research. I wanted to talk to our fellow clinicians and have an office-wide approach knowing that the only real CI to vaccination is allergy to a vaccine ingredient. This person is in a forward facing, public law enforcement position. What would be your guidance for this case as well as to guide policy/protocols (knowing there is always some flexibility for clinicians when we issue protocols here)?
2.) This is more personal and sorry for the length. On 7/4 my 45 y/o otherwise healthy husband developed chest pain that he first thought was m/s in origin but watching him for a few hours I suspected was not. We went to ER and he had elevated d dimer and subsequent CTA revealed multiple R PE. Incidental finding was a nodule in R thyroid that is currently under evaluation though work up to date has been negative (FNA neg, cardiology neg, coag studies net, etc). The question-he had received the J&J vaccine 10 weeks prior to this incident and had been feeling fatigued (though thought it was due to inactivity for a few weeks) for a few weeks prior. Reported to VAERS and they followed up right away to get his records but of course we don’t know and may never know if this was a causative factor for the PE, so in the near certain case that he will also need a booster, should he opt for one of the mRNA injections instead of another J&J? He’s currently on eliquis (through 1/22) so should I plan to get his booster while on the doac to decrease risk?
Thank you again for considering my questions. I’ve asked locally to our ID and other PCPs and hospitalists and we are a bit divided and I don’t see any research specific to help guide. I know you don’t know me but I feel like I know you (and Vincent and crew on TWIV!) very well!
Multas Gratias,
Jaime Tompkins
FNP-c, DNP
she/her/hers
Lin writes:
Good evening Dr. Griffin
Just listened to an Andy Slavitt podcast with Johns Hopkins epidemiologist Jennifer Nuzzo. Very worthwhile discussion of post-vaccination infection (note that I don’t use the word “breakthrough.”) There was some discussion as well about boosters and my impression was that global vaccine equity plays too small a role in the booster decision. But that’s not where my two questions for you lie.
After the interview was over Slavitt opined on several Covid-related matters. He did a good job explaining waning (neutralizing) antibodies and memory T cells responding to viral attack. He then went on to say that the memory B cell and T cell response is slower to appear and that could lead to symptoms and disease before full immune response kicks in. His argument for boosters is that those antibodies that appear directly after a boost will afford more protection against symptoms and disease. If you’re dead set against symptoms then a boost is your thing. Is this correct? To his credit, Slavitt gives a very well articulated discussion on the pros and cons (politically and medically) of boosters. He feels that boosting the immunocomprised, vulnerable elderly and health care workers in the US is fair. Boosting everyone else before the rest of the world has vaccine access is not.
Second question: Slavitt said that smarter people than he are pushing for the J&J vaccinated (of which I am one) to get an mRNA vaccine. Where is the data that supports this? And would it be one dose or two?
Dr. Griffin, many thanks to you and Dr. Racaniello for the hard work you put into your podcasts and updates. These are absolutely the most informative and reliable reports of all that I subscribe to (and that is many!) They also rate high as info-tainment.
Warm wishes
Lin
the retired molecular biologist from way western MA and grandmother to the epitope-obsessed grandson.