Gladys writes:

I have a question for my daughter who is seven weeks pregnant due for a booster and just caught COVID last week and was quite sick. My question is should she still get the booster in the second trimester having had COVID while pregnant at seven weeks.

Thank you again so much from your many faithful followers.



Scott writes:

To include in your show notes, a direct link to request 4 free at-home rapid antigen SARS-CoV2 tests provided by US government. It takes about 30 seconds to fill in your information and submit.


Madison, WI

Imad writes:

I listen to Daniel Griffin’s weekly updates religiously, and was very excited to hear his report regarding the “Risk factors for severe COVID in vaccinated” paper in MMWR. He reported:

0.015% of vaccinated individuals developed severe covid-19 outcomes

0.0033% of vaccinated individuals died

This sounds amazing, and Daniel compared this to our pre-vaccine risks of:

10-20% of individuals of people getting infected ending up in hospital

~2% case fatality rate

My concern is that he’s not using the same denominator, namely the number of individuals who got covid 19. The paper states: “Among 1,228,664 persons who completed primary vaccination during December 2020–October 2021, a total of 2,246 (18.0 per 10,000 vaccinated persons) developed COVID-19 and 189 (1.5 per 10,000) had a severe outcome, including 36 who died (0.3 deaths per 10,000).”

This seems to translate to:

189 / 2,246 = 8.4% risk of developing severe outcomes

36 / 2,246 = 1.6% case fatality rate

This is perhaps slightly better than the pre-vaccine numbers. Obviously being vaccinated reduces your risk of developing covid-19 in the first place, but that benefit seems to have decreased significantly with Omicron. Is Daniel painting much too rosy a picture here, or am I misinterpreting the data?

Thank you for the amazing service you provide to all of us each week.

– Imad

John writes:

Really enjoy your podcast and have relied on you and the TWiV crew for regular updates through the pandemic, especially over the last year. I just finished listening to episode 850. 

I have a question regarding your and the TWiV team’s focus on severe acute outcomes and death when talking about vaccination. You highlighted very high rates of cognitive impairment and fatigue in the meta-analysis about Long COVID this episode. Looking at the paper, it seems that objective measures of cognitive impairment found an even higher rate than asking people subjectively: 36%! It also seems that hospitalization and overall acute disease severity is not a good predictor of long COVID severity. From what studies I have seen so far, vaccines are probably about 50% protective against long COVID in people who do get infected (please let me know if this is inaccurate). Many studies also seem to show the symptoms continue to persist at the end of whatever the study period is and we don’t know whether they will ever resolve at this point. In light of all of this, doesn’t it make sense as a public health goal to consider vaccine efficacy against infection and try to prevent all infections, not just keep people out of hospitals? This seems particularly relevant for younger, previously healthy people and children. 

A second, and less important point. I am completely with you and the TWiV crew on the importance of vaccination and I appreciate the rigor you bring to your discussions. I noticed, however, you seemed to be comparing the unvaccinated case fatality rate of 2% to the observed rate of death of 0.003% among vaccinated people during the period December 2020-October 2021 in the MMWR. Is this a fair comparison? The 2% number is the fatality rate after confirmed infection, and is not dependent on time. Not all of the people in the MMWR were infected during the observed time period, right? Please feel free to let me know if I’ve misheard or misunderstood. 




John Leikauf, MD

Clinical Assistant Professor

Child and Adolescent Psychiatry 

Stanford University School of Medicine