Chris writes:

Hi Vincent and Daniel, 

Can either (or both) of you discuss the longevity of smallpox vaccination in light of the current monkeypox scare?

The spread of the disease seems to be increasing rather than slowing, from my reading, and as for SARS-CoV-2, the public health response is practically nil. 

I am traveling reasonably often, and understand that contact with surfaces (including bedding – as in hotel bedding)  that infectious persons have also contacted can lead to transmission.

I am 68 and remember getting the oral polio vaccine in second grade as a child in Texas. I may have also gotten another polio vaccine via scarification within a year or two (I don’t remember getting the vaccine clearly, but I have a small scar on my shoulder). 

Is it likely that persons of my age who were vaccinated against polio will be capable of mounting an immune response to monkeypox (or smallpox)?

Best regards, 

Chris Boles, Ph.D, Chief Scientific Officer 
Sage Science, Inc.,

Harrison writes:

I read that Dr. Fauci did not take Paxlovid immediately after testing positive for SARS-CoV-2 because he had mild symptoms. When his symptoms worsened he began Paxlovid. It is unclear exactly what day of his infection this was. It would seem that he would have been better served by starting Paxlovid immediately being a high risk individual to maximize the effect on viral replication?

H. Bradford Hawley, MD, FACP, FCCP, FIDSA, FSHEA

Jeff writes:

Hello Daniel,

I’m a Canadian physician (with an undergrad background in virology/immunology/molecular biology) and big fan of TWIV.  I do a combination of emergency medicine and family practice.

I love the way you breakdown timing and treatments of Covid-19.  In general I completely agree with you in regards to not starting corticosteroids until the patients start dropping their SpO2, and not throwing around antibiotics.  In general I do not prescribe antibiotics without a valid indication.

But I have to wonder about whether this may result in a shift in how we approach COPD.  Historically the group I was relatively liberal with antibiotics was those with COPD.  We tend to have patient self-directed action plans where patients start their own antibiotics for COPD exacerbations.  And historically we have been moderately liberal with corticosteroids in this population as well.  I have even seen some COPD patients with action plans with prednisone for them to start when their COPD is exacerbated.

Do we need to reassess these action plans and/or our approach?  For the patient who diagnoses themselves at home with a false negative RAT, could a patient with COPD harm themselves by starting their prednisone too early if the virus triggering their COPD was covid-19?

Likewise, working in the emergency department, if I see a COPD patient who has a (false negative) RAT have I potentially harmed them if I start them on prednisone for their exacerbation, particularly if their PCR is positive a few days later (or PCR is not done – we are often doing serial RATs and admittedly not every patient is doing enough RATs that I would be confident they have completely ruled out COVID-19.)

So do we have to be more diligent in ruling out SARS-CoV-2 presence when seeing patients with Acute Exacerbations of COPD?


Dr Jeff Rader
Sparwood, BC

Anonymous writes:

Hi Daniel and Vincent,

I’ve been listening to your podcast and I’m very grateful to have such a trustworthy source of Covid information.  I’ve been wondering for a while – we know that most people are most contagious in the 1-2 days before symptoms start. So presumably before a +antigen test.  We have also been using antigen tests as a marker for infectiousness- not clearing precautions until the test is negative.  How is it that we are most infectious before that test turns positive?  

Thank you!