In his weekly clinical update Dr. Griffin discusses guidance for prevention and treatment of monkeypox, post-infectious symptoms among children and adolescents, profiling post-infectious syndromes of different variants, comparison of vaccine Ankara vs intradermal routes of administration, infection in vaccinated individuals treated with or without PAXLOVID, duration of symptoms with positive rapid antigen after infection, epidemiologic characteristics of monkeypox, and sequelae of post-acute infection.
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Download TWiV 926 (28 MB .mp3, 46 min)
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Links for this episode
- Guidance for prevention & treatment of Monkeypox (CDC) 3:19
- Post-infection symptoms among children and adolescents (CDC) 20:06
- Profiling post-infection syndromes in different variants (medRxiv) 29:49
- Comparison of vaccinia Ankara (MVA) vs intradermal routes of administration (NIH)
- PAXLOVID patient eligibility screening checklist (FDA)
- Remdesivir fact sheet for providers (Veklury)
- Bebtelovimab fact sheet for providers (FDA)
- Infection in vaccinated individuals treated with or without PAXLOVID (medRxiv) 25:45
- Duration of symptoms with positive rapid antigen after infection (J Virological Methods) 10:28
- Epidemiologic characteristics of Monkeypox (CDC) 4:07
- Sequelae of post-acute infection (ScienceDirect)
- Contribute to Floating Doctors fundraiser at PWB 33:32
- Dr. Griffin’s treatment guide (pdf)
- Letters read on TWiV 926 35:25
- Timestamps by Jolene. Thanks!
Intro music is by Ronald Jenkees
Send your questions for Dr. Griffin to daniel@microbe.tv
I want to say that I really enjoy TWIV and the clinical updates. These podcasts have kept me up to date with COVID since I began listening in October 2020 and the information has helped me become a better COVID 19 case investigator and epidemiologist. So thank you so much for spending so much time doing these podcasts! On the evening of July 17th I started to get a sore throat. I woke up Monday the 18th with it still there so I took an at home COVID test and it was negative. I learned from listening to TWIV and following Michael Mina and Daniel Griffin on Twitter that the infectious period may be delayed especially those who are vaccinated and have had a booster. I tested again Tuesday morning July 19th and tested positive on an at home test. I immediately went to MedExpress in Huntington, WV in hopes they would give me Paxlovid. I was told, “yeah, we don’t recommend that here” and proceeded to prescribe me steroids and a cough syrup even though I didn’t have a cough and even though steroids are not to be given to people in the first week of symptoms who are not hypoxic nor in the hospital. I left very disappointed and called my family doctor in Teays Valley, WV. I asked for Paxlovid and I was met with “sorry. we only give Paxlovid to high risk individuals and we are prescribing steroids and antibiotics”. I’m obese due to lipedema and I had a total thyroidectomy in 2015 due to thyroid cancer. I thought that would put me high risk but I guess not. I was so upset that I gave up and just decided to take acetaminophen for my headache then switched to Walgreens version of Mucinex once they delivered it to my house. I didn’t pick up the steroids or cough syrup that I was prescribed. That Wednesday night on July 20th was kind of a scary night for me. My head was so congested that my eyes hurt, my head hurt, my teeth hurt, my ears hurt all the way down into my neck and it felt like I swallowed glass. I had laryngitis and could barely talk. Everything was so inflamed and swollen from the neck up I was afraid that I wasn’t going to be able to breathe through my mouth even. Thursday morning I called a different healthcare facility in Barboursville, WV and asked if they would give me Paxlovid. They said yes but they were going to charge me, in addition to a visit fee, $40 to be tested for COVID before they would give it to me. I asked if they could just use my at home test and the test from MedExpress so I wouldn’t have to pay the $40 for something I already knew I had. They said “no”. So I ended up not going to that healthcare facility and not getting any Paxlovid. Luckily the next day my symptoms began to ease up but my sinus congestion didn’t completely clear up until the 2nd week of August. My experience trying to get proper treatment for COVID has been a very disappointing one. My friend ended up testing positive about 2 weeks after me and she was prescribed steroids in her first week of symptoms as well even though she was non-hypoxic and not hospitalized. Do you have any suggestions for those of us who ask for Paxlovid and are refused the treatment? This was my first time getting COVID, and hopefully my last, but I want to be better prepared for if I do happen to get it again and refused Paxlovid.