Kevin writes:

Hi Vincent and Daniel,

Thanks for doing the podcast.

We live in Switzerland which royally screwed up getting the under 12 year olds vaccinated and  only slowly started rolling it out in the last week. E.g. slow to approve the vaccine, failed to order in time, poor logistics, etc.

So, a couple weeks ago, we did what many parents here were doing and crossed into a neighbouring country to get our kids vaccinated; Germany in our case but I have friends who have taken their kids to Italy and Austria.

As well as vaccinating our 6 year old we were also able to get our 4.5 year old and our 2 year old vaccinated. All children were vaccinated with a Biontech 10mg dose. The vaccination center we visited could also have given them a half dose (5mg) but wouldn’t have been able to do the 3mg dose that is currently being evaluated (with seemingly “meh” results so far).

I don’t think off-label vaccination is something you’ve talked about on the show before, maybe it’s not even allowed in the US. I’d be interested to hear your thoughts on the matter. Would you add a caveat to your mantra, “never miss an opportunity to get a vaccine”?



You might get a laugh out of this.

The schools / kindergardens here pretend to be “safe” places because they implement the following test schedule every week.

– Tuesday: pool PCR test for every class

– Wednesday evening: results of the pool test

– Thursday: collect samples from every kid / teacher in a positive pool -> run individual PCR tests.

– Friday evening: Maybe get the individual results from the lab. Often parents are never told the results.

– Monday: The kid that caused the positive PCR test 6 days ago finally stays home.

Mason writes:

Hi Dr. Griffin,

Mason here, an MD/PhD student in Chicago. Thanks so much for the work you and the rest of the TWiV team do to distill the mountains of information about COVID these days. Even as just a student, I often use a lot of the information you provide in conversations with colleagues and patients. 

My question is regarding Paxlovid- I’m a little concerned that the drug is co-packaged with ritonavir. As a potent CYP3A4 inhibitor, ritonavir will impact the metabolism of many drugs other than the nirmatrelvir it is packaged with. The EUA for Paxlovid mentions many of these drugs in the Fact Sheet for Healthcare Professionals (linked below), which include warfarin, amlodipine, prednisone, and several statins just to name a few. Does this lengthy list of drug interactions prevent the use of Paxlovid in the high-risk populations who need it most? I’m curious about how many people who qualify as having “high risk for progressing to severe COVID-19” take one of these drugs, and if they can be safely treated with Paxlovid. Would many of these patients be limited to only receiving monoclonals or the less effective molnupiravir? Is this a concern you are facing in the clinic, or is it simply a thought in a naive medical student’s mind?

Thanks again for all you do,

Mason Clark

Fact sheet- 

Philip writes:

I try to rinse my nasals daily using a Netti Pot with a saline solution.  Not necessarily for Covid reasons.  

Would a nasal rinse before a nasal swab for a Covid test lead to either increasing false negatives or reducing false positives?

Thank you.

Ali writes:

Hi Daniel,

I’m a school nurse for a middle/high school and my husband is a family practice PA. We have noticed that antigen testing seems to be more accurate on day 3-4 after symptoms (even more so with Omicron), and in general, day 1 of symptoms the antigen tests are not picking up positives. I’m this weeks TWIV clinical update, you stated that the viral load is likely to be highest on day before, day of and 1 day post symptoms. If the antigen tests pick up a viral load, why are they not showing positive at this early stage of virus, and picking up fairly routinely on day 3-4?


Alli and Barry