Dear Dr. Griffin:

My wife & I are two Pharm.D.’s in San Francisco & we’ve been glued to TWiV & your Clinical Updates since the beginning. (I’m also a DDS, but I’ve found my Pharm.D. training to be more important during the last 2 pandemics—HIV & COVID-19).

I have a real Lu-Lu of a case report & wish to know if you’ve heard of this possible adverse vaccine reaction.

57 Y.O. Endodontist.

June 2020 uncomplicated course of COVID-19.

Received 3 doses of Pfizer (1/30/2021, 2/20/2021, 1/12/2022.

6.5 days after his #3, he started acting “whacked-out” in his office. He thought he was having a stroke.

Severe auditory & visual hallucinations.

Rushed to the E.D.

Systolic BP >200.

Toxicology: negative.

MRI: non contributory.

Further work-up found “inflammation of the lining of the brain.”

Terrible hallucinations & fear of dying continued until 2 days after admission when he received first dose of I.V. Steroid. Within hours his Sx’s resolved by 95%.

One more dose of I.V. Steroid and he was discharged with 1 week of P.O. Steroid dose-pack.

He’s taking a week off from dentistry.

I see that there are scattered case reports of acute encephalopathy following mRNA COVID vaccine. It appears this adverse vaccine reaction is rare and I am interested to hear what you have heard.

We certainly do not want to add any more fears to an already vaccine-hesitant culture, but if this problem is happening, clinicians should be made aware so that prompt therapy can be initiated.

Over the past 2 years, we have become the repository of and megaphone for spreading your timely & accurate SARS-CoV-2/COVID-19 information.

Please know how valuable you & the TWiV team are to so many.

Thank you,

Kip Potter, Pharm. D., DDS
Laura Potter, Pharm. D.

Beth writes:

Hello Dr. Griffin!

We are regular listeners and we greatly appreciate all the helpful updates. Thank you!

Our question has to do with corticosteroids such as inhaled asthma medicines (Beclomethasone dipropionate) and also nasal allergy sprays like Fluticasone.  If a patient takes these drugs regularly, should they stop taking them if they get Covid?  I believe you have said steroids are contraindicated during the first week of an infection. I also seem to recall there were early reports in 2020 that drugs like fluticasone may prevent serious disease.  Can you clarify what the latest research says?

Thanks so much!

– Beth, fully vaccinated and boosted!

Debora writes:

Dr. Griffin,

I have been listening to your clinical updates religiously for over 18 months.  Typically this is followed by a number of clinicians chewing on your update the following Monday at UNM’s ECHO COVID-19 Questions & Answers.

Thank you for your regular helpful information and also your global perspective [I also worked in Bangladesh so appreciate you bringing up neglected places on the earth]

I work in an out-patient covid clinic and one of the issues that remains unclear is care for patients that are newly infected with COVID-19 and require oxygen but not hospitalization.  I understand that they do not qualify for monoclonal antibodies nor antibiotics.  I know typically steroids are not recommended if patients are not on oxygen but there is some data to prescribe steroids inpatient if on oxygen but questionable outpatient.  Will you please go through the data and recommendations.  Specifically, the timing.  Is it best to wait 10 days in order to not potentially prolong viral shedding?  I also suspect that many of these patients should probably be hospitalized but haven’t been due to lack of local resources [they are discharged from the ED on oxygen].

Thank you

Debora Bear, MPH, MSN
Family NP

Mario writes:
Hello Dr Griffin,

I have a 15 year old daughter who is vaccinated (April-May 2021), not boosted yet.

She contracted mild symptomatic Covid on 12/28

She’s recovered now. Thank God. 

Are there any data that we can look at to say a booster is or is not advantageous for a previously vaccinated teen with 2 comirnaty doses after recently getting Covid? 

Presumably, she has protective antibodies against omicron, right? And probably developing cell mediated immunity? So she wouldn’t need the extra antibody boost that the vaccine would give her? Or would she benefit from the extra antibodies and the cell mediated immunity from the vaccine? 

I would appreciate your response. Thank you so much for what you and Vincent are doing! I look forward and enjoy your weekly clinical updates. I’m a family medicine doc in Los Angeles and these twiv videos are informative for my practice. I wish I could get cme for that! Lol.

Have a great weekend!