Martin writes:
Hello from the UK
1. Please can you advise on typical ‘progressive’ dosing strategy with dexamethasone, when covid-19 reaches a stage where blood O2 drops below 90’s.
I’d like to understand, to what extent, dosing is typically increased when a Patient’s O2 drops from low 90’s into the mid /low 80’s, or worse.
Is it normal practice to ‘dose higher’ the greater the drop in O2 and – if so – what dosing limits / boundaries are typically observed to avoid risks of compromising the immune system’s battle with the virus?
2. Also, are you reasonably comfortable with substituting Methyl Pred, Prednisone, Prednisolone, or do you stick rigidly with Dexamethasone?
Thanks for all the great work you do and for the valuable insights you provide.
Regards & Best Wishes
Martin
Nolan writes:
Dr. Griffin,
I’ve greatly enjoyed your weekly updates, as well as the rest of the TWIV content. I’ve been thinking about your “scaring the wrong people” formulation. I agree many of the stubbornly unvaccinated are not going to be persuaded by new data, while the boosted and masked remain in a state of anxiety. I think the PTSD being experienced by the latter is caused by an inability to address one’s risk once you’ve taken the basic precautions (vax, mask, test, distance). This is exemplified by people asking about a 4th or 5th vaccine dose.
Epidemiology shows obesity to be major risk factor for COVID outcomes. Working on your BMI is something you can do alone or with your PCP. Personally, I’ve been doing my best to get my BMI out of the “COVID danger zone” since this pandemic started. I appreciate PCPs are regularly asking their patients to lose weight, and this may seem outside of TWIV’s interest, but the extra motivation of avoiding bad-COVID and giving people the agency to get their worries under control might be effective. Two birds!
Additionally, We now have some mechanistic data indicating SARS-CoV-2 might be *infecting* adipose tissue and causing local inflammation, which begs the question whether viral replication and inflammation might scale with large deposits of fat.
https://www.cell.com/cell-metabolism/fulltext/S1550-4131(21)00621-5
https://www.cell.com/cell-metabolism/fulltext/S1550-4131(21)00428-9
https://www.biorxiv.org/content/10.1101/2021.10.24.465626v1
Surgical means of weight loss also help:
https://jamanetwork.com/journals/jamasurgery/fullarticle/2787613
Thanks for your thoughts!
Nolan G. Gokey Ph.D.
Kelly Government Solutions at NIEHS/NIH
Epigenetics & Stem Cell Biology Laboratory
Chromatin & Gene Expression Group
National Institute of Environmental Health Sciences (NIEHS)
Alan writes:
Dear Dr. Griffin:
As COVID-19 evolves, your podcast becomes even more relevant to clinicians. My questions relates to the choice of therapy for COVID-19 for a patient with moderate disease who has risk factors such as age greater than 65 or obesity. If either Paxlovid or Sotrovimab were available, which one would you prefer? I will also assume the patient would be willing to come in for the infusion if this was the better option.
Do you see a role for combination therapy for immunocompromised patients?
Thanks for all the good you do.
Alan Rosman, MD
Bronx VA Medical Center
Marcia writes:
My question:
My daughter-in-law had her two jabs prior to getting pregnant. Now she is ½ way through her pregnancy. She is due on Mother’s Day. It is just over 6 months since she had her last jab. Her OB Doctor doesn’t want her to get a booster as he is worried about the booster vaccine affecting the fetus.
I believe she should get her booster now but I cannot overrule her OB doc.
They have a 2 year old and a 3 year old, and I want all of them to have protection. Covid is not a good thing in pregnant women.
Where do OB docs get their information about giving boosters to their patients? He said he is checking into this. We think he is a good doc. He delivered her first two children.
What do you think? Can you let me know if and when you will answer this question?
Thanks so very much,
You are all the best!
Marcia