Albert writes:

Dear Dr. Griffin,

I am returning to the US from 2 years in Mexico. I am 75 with mild hypertension, a BMI of 30, asthma and Afib. I got two shots of Sinovac in June and July 2021 and an Astrazenica booster in February 2022. None of these vaccines is FDA approved so technically I am unvaccinated in the USA. Would you recommend I get an mRNA booster — a 4th shot?

When I asked in Vincent and Amy’s livestream April 6, Dr. Racaniello said he didn’t think so but he would ask you, so this is a reminder. I never miss your weekly commentary. Thank you for all you do.

Cordial regards,


Mike writes:

Hello, Dr. Griffin.

I am a retired family physician who has become addicted to TWiV.  I recently read an interesting post on Medscape about post-operative infections after epidural or joint injections, using longer-lasting steroids like triamcinolone. These injections doubled the incidence of post-op infections for up to 90 days after the steroid was given. 

My question is: Has the impact of longer-acting steroids been studied in relation to Covid infection outcomes in un-vaccinated, vaccinated, and boosted patients? It seems likely to me that the same effect seen in the meta-analysis quoted in Medscape, would also apply to diminished immune protection for Covid patients.

Thanks for all that you and the TWiV team are doing. We donated to Parasites Without Borders during the November matching campaign to TWiV, and we intend to do so again in the future.

Here is a link to the article in Medscape:

Thanks again,

R. Michael, MD (Ret.)

Seattle, WA

Bonnie writes:

Dear Dr. Griffin:

The reporting that I hear about masking is so all over the place right now that I don’t know if my question is foolish or not.

Before the pandemic, I used to volunteer at a correctional facility, and I’m looking at returning to volunteering. I went back last week to get fingerprinted, and as it happened, the facility had just decided to end its masking policy. Those of us in the fingerprinting group were encouraged not to mask (although I kept my N95 on anyway). 

My concern is: our state puts vaccination rates for inmates of correctional facilities online. So I know that the rate of vaccination in this particular location is around 44% for two mRNA doses, and 46% for having had just one. The volunteers, on the other hand, are generally double vaxxed and boosted (personally, I had the J&J and a Moderna booster). 

I understand that having been vaccinated, I should not worry overly about myself. However, aren’t unvaccinated people still quite vulnerable? And thus, shouldn’t I and other volunteers still mask when visiting this facility for the protection of the inmates (who we meet with in a fairly small, not well ventilated room containing 8 or 9 people)? They don’t see visitors in person, except for volunteers.

I work at home and don’t spend a lot of time around other people, but I still wonder if, unmasked, I would be putting the inmates at risk that I might inhale viral particles downstairs, where lots of people pass through a tiny lobby all day long, and exhale them upstairs.

Previously, the inmates were provided with surgical masks, but apparently they are no longer wearing masks now that the facility has decided that’s unnecessary. My fellow volunteers are thrilled not to have to wear masks, and of course, it would be nice to see everyone’s faces, but I’m worried. Moreover, I think that volunteers wearing masks are a signal to inmates that the pandemic is still a concern, and it gives inmates the opportunity to ask us about the pandemic–so that even though we are going in to teach meditation, we could be ambassadors for the idea of getting vaccinated.

As someone who travels around the world, you must personally face this question a lot: What is your solution for keeping the people around you safe if they have not been vaccinated? Are you wearing a mask when treating unvaccinated patients? And if so, do you have thoughts about how to diplomatically explain to others why you are doing so? I know you must receive too many questions to be able to answer them all, but if you have time for this one, I would really like to hear your thinking on this. I don’t think it applies just to me, but to volunteers all over America in all sorts of settings who would really like to go back to volunteering and are trying to do so in a safe and responsible way. 

Thank you for all that you do.