Kari writes:

Hello Dr. Daniel Griffin,

I am a 42 year old pregnant woman with no health conditions other than celiac disease, food allergies and mild asthma during wildfire season. I am due October 8 and have been vaccinated x3 with Moderna, last dose (booster) was almost one year ago in October 2021.  You mentioned a few weeks ago that Paxlovid would be an important consideration for pregnant women who test positive for COVID, even with no other high-risk conditions.  Because our oldest will be starting Kindergarten this August, our exposure level is about to skyrocket and I asked my OB about my risk and Paxlovid.  He seemed to be unconcerned, confirmed I was vaccinated and boosted and said “you will probably be fine”. I called local public health and they didn’t know about eligibility for pregnant women. I contacted CDC who forwarded me to Mother to Baby. Mother to Baby didn’t know but expressed concerns about Paxlovid and it’s unknown safety during pregnancy. 

My questions are: 

Did I understand correctly that, even with no additional risk factors other than pregnancy, that I should advocate for myself and find Paxlovid if infected during/shortly after pregnancy? 

Due to my age, pregnancy, and the fact that my blood gestational glucose test just came back “mildly elevated”, should I revisit this concern with someone? Any recommendation on how/with whom to best proceed?

Is there vaccine effectiveness data for those under 50 years and boosted almost a year ago in regards to severe disease? Is there any information about this in the context of pregnancy? 

Thanks so much for your information. I learn so much from listening to you and everyone at TWIV, and the information you provide is very important for scientists, medical professionals, and those of us in the general public just trying to navigate the pandemic.

Genevieve writes:

Hi Daniel (and Vincent),

Thank you for your amazing updates every week. I find them invaluable.  

My father is 80 and is fully vaccinated with 2 boosters (Pfizer). He uses the local VA hospital for all his healthcare needs. He has not contracted COVID yet. I want to have a plan in place in case he does but I’m having a hard time navigating the resources available from the VA.

He is on lifelong Xarelto due to history of two DVTs so he will not be a candidate for Paxlovid. Do have any suggestions to finding out what Covid therapeutics are available at my local VA? We live in Portland, Oregon.

Thank you for all you do,

Genevieve Van Herk, Pharm.D., RPh

Bistra writes:

Dear Daniel,

I am trying to understand what is the protection of previous infections from getting infected and reinfected right now and the risk of complicated illness from repeat infections. I want to advise my elderly parents (83 and 79) as they live in a country with poor pandemic response. They have 2 AZ doses and 1 Pfizer booster and just recovered from covid with somewhat mild illness (2-3 days of fever + post-illness exhaustion) without the need for hospitalization.

What are the next steps for them? Continuing to mask is a given, even though no one masks where they live. But they need physiotherapy appointments (which is how they got infected now), want to see friends, and need some socializing. The social isolation has been extremely hard for them and created some mental health issues for my dad who also takes medication for chronic illnesses and can’t easily medicate for mental health. How much should they avoid socializing?  When should they get a 4th booster? It hasn’t been well mandated in their country so they never got it and my dad who has a history of strokes, had a blood clot post second AZ shot.

In general, what does natural immunity coupled with vaccination do for us?

In my circle, everyone who got infected this month were people vaccinated but without previous infections. A family of 4 on a commercial flight, despite wearing KN95, and I from attending a scientific conference where we didn’t mask.

Yet, those who had covid in early 2021 and later got vaccinated have not gotten infected again despite many exposures and general no masking or social distancing. I’m sure some it’s luck but also is there data to read about it?

Many thanks,