John writes:

If I heard it right, Dr. Griffin said that Paxlovid can or should be given for asymptomatic infection. I’m confused! I thought the EUA was for use on patients with a positive test, mild-moderate COVID-19, and high risk for progression. You don’t have COVID-19 unless you have an illness, which means at least symptoms. I think he meant to make the point that once there are symptoms, if the patient is otherwise eligible, you don’t wait to see if the symptoms worsen. I wouldn’t fault a doctor for prescribing Paxlovid to a very high risk asymptomatic patient, say, an unvaccinated organ transplant patient, when you know the time of exposure or conversion of the test – but as I understand it, that would be going outside the directives of the EUA.

John Munger, MD

Clark writes:

Dear Dr Griffin,

I would like to say thank you for all the time and energy you’ve put into educating about SARS-CoV-2.  I first heard you speak towards the beginning of the pandemic on a conference call with Kentucky providers when I was back in the US; however I spend most of my time in western Kenya at a relatively large referral hospital where I run the pediatrics department, and, for the last few years, our respiratory isolation unit.  Your weekly updates have been invaluable for me keeping up with the literature and updating our protocols and practices.  It has been in many ways a heartbreaking few years – last year we had 183 mortalities from COVID in our unit as we are the only ones for about a 4-hour radius doing critical care – but I think it would have been significantly worse without you taking the time to distill and propagate the current literature.  I also really appreciate your gentle and humble demeanor in approaching what has unfortunately become a very polarizing disease.

May the Lord bless you and keep you.


Clark Sleeth

Tenwek Mission Hospital, Bomet, Kenya

Deidre writes:

Hi, I wanted to thank you for your clinical updates which have been invaluable over the past few years.  I’m a physician who has been asked to prescribe paxlovid to a patient who is traveling to Europe, specifically Italy, for several weeks, for the patient to have on hand to take if she were to test + while overseas as it’s not exactly clear what her access to such treatment would be if she were to get Ill while there. The patient is vaccinated and 70 years of age with hypertension and obesity.  From a creatinine and drug interaction standpoint, it would be appropriate.  If she were to test positive in the US, I would prescribe her paxlovid.  I know the med is not approved for post-exposure prophylaxis, but that is not exactly this scenario, and if there were significant shortages it wouldn’t be appropriate, but I’m wondering if you think this is possible or if you know what the access to antiviral drugs is in Europe?