Bob writes:

Dear Twivers.

Just to break with the usual, I will start with the “however” and close with platitudes (you can assume the best).

I am writing from my office on an inpatient ward in a rural Ontario hospital.  As I came in this morning, I double-checked that among our 25 patient rooms, there are only 2 negative-pressure rooms (i.e., the beds in which one would bunk down patients who have an infectious disease).  Based on current news reports, I would bet our team would reflexively send cases of Monkeypox and Covid most quickly to those negative pressure rooms… assuming they were not already occupied…  which they always are.  

Is the chronic high baseline strain on staff apparent? 

Which brings me to the attached screenshot … from our feds’ Covid website, the chart illustrates our national hospital covid occupancy over time, where you can see that Jul 2022 is shaping up much differently than both Jul 2021 and July 2020.  I should note that the unusually high Jul 2022 occupancy exists despite the fact that Canada’s vaccination coverage is very high (over 85% have received at least one dose).  

Important to note for you that our continued hospital strain is not generalizable to the US where your covid occupancy is thankfully not an issue right now.  But if it were, I would remind you of the MMWR report from 2021 predicting 80K excess deaths if ICU capacity were to exceed 100% (link immediately below).  I think that finding is generalizable to us in Canada.

Also of concern for a province such as our with huge variance in population density… 80% ICU occupancy in big Toronto might not be a concern, but I could imagine when “ICU” capacity even gets above even 70% or so in a rural hospital such as ours, summer “ICU” staff will consist of generic licensed providers of all stripes, each a stranger to the next.  

All to suggest that from a public health perspective, “hospitalization” is appropriately the favored metric for determining where the pandemic is right now, at least in our province.  As evidence of that shared sentiment, I also am providing a link to our local Health Until Wastewater Surveillance Charts where you can see each station’s RNA counts are graphed against its respective neighbouring hospital’s occupancy.

Platitudes… what can I say, except to further note that my ward is a psychiatric ward and I am a psychiatric researcher with more than a passing interest in all things character.  How ironic that when I think of the finest examples of ‘character strength and virtues’ demonstrated over these past two years, I most times turn to you TWIV virologists!   Keep up your fine modelling of what it means to be both great scientists as well as great world citizens.  Humanity needs more of you.

Stay safe,


Steve writes:


When Vincent asked about big bands today, Dickson initially said there were some; then your quick web search indicated all the most recent bands are from the 1970s. 

The reason for this is pure economics: the number of performers on stage, their adequate remuneration + travel costs combined with the need for a big band to play in a venue that is neither too small (too few seats to make a profit) nor too big (a stadium is great for a fully amplified rock band, but unacceptable for big band musicians’ aesthetics) means the art form is economically not viable in our times. 

A big band of today, even one made up of the living, still performing greats from the older bands (like Chris Botti) considering a tour for say, six months out of the year, will always lose money on ticket sales alone. Therefore, a band like this would have to depend on grants or private donations. Indeed, when any of us hear a big band on limited tour live today, it has been subsidized by one or both of these means.

Compounding this last statement, big bands don’t attract much grant money as they practice what is considered to be an “old” and “niche” art form. But the “niche” part of this is only true because there are no classic big bands touring around these days! It is a circular and self-defeating economic conundrum.

No need to read all this verbiage on air, as a humble musician I only hope to give back a little illumination from my field in return for the amazing wealth of virological understanding I have received from all of you and your guests on TWIV over the years!

Kind regards,


Mary writes:
Dear TWiVers,

Thank you for all you do.  I am gasping here in the back after trying to follow the Offit machine-gun delivery.  You all responded by exceeding the speed limit to which I am accustomed as a long time listener.  You all were stars in this episode!  However.

I don’t really understand why we shouldn’t modify the COVID-19 vaccine.  We modify the flu vaccine every year on account of changes in the virus, so why not COVID?

Only an accountant,


Kim writes:
Hello TWIV,

Do you think monkeypox should be a concern for people participating in close contact sports like judo, wrestling, and Brazilian jiu-jitsu?  If so, should participants consider getting vaccinated?

Thank you,


Mark writes:
Hi Vincent, Dickson, Kathy and Rich. I want to thank you all for the wonderful, informative and balanced podcast; I know of no other up to your academic and clinical level.

I just finished the 7/10/22 episode (“Boosters On”) with Paul Offit. I think Paul is a wonderful doctor and Infectious Disease Specialist, as well as an excellent researcher (I worked under him during my Infectious Diseases fellowship at CHOP years ago). I loved the discussion, and agree with his views regarding the low-risk of fully vaccinated individuals coming down with severe Covid illness. One point that was not brought up during the podcast is the issue of asymptomatic viral spread, or viral spread during or just after a mild Covid infection in the fully vaccinated. One may feel well or just mildly ill after infection, but your chance of spreading Covid must surely be higher than if you never were infected at all. 

As a 65 year old fully vaccinated (and boosted x2) pediatrician, I am not concerned with becoming significantly ill myself, but I keep awake at night with the fear of becoming infected and inadvertently spreading disease to my patients and their families. For this reason I have not lowered my guard in avoiding indoor gatherings if not necessary, and I always mask in public when a public gathering is absolutely necessary. 

Perhaps you could address the (little) data available regarding infectivity of those with Covid after full vaccination (even those only mildly ill), and the risk that those individuals might inadvertently spread disease to their contacts.

I understand we are all tired of this pandemic, and numbers have fallen significantly. But when the USA daily death rate (hovering around 500/day; NY Times Coronavirus Tracker) is the equivalent of a jumbo jet crashing to the ground with all hands lost daily, and is 5 times the USA daily death rate of automobile deaths, gunshot deaths and influenza deaths (all about 100/day), I can’t see how we can get back to normal and accept these deaths as part of routine life. I’m still a strong believer of “Primum Non Nocere”, and don’t want to contribute to the problem, if I can help it. I just don’t know when, if ever, we will be able to get back to a normal life.

Mark Mangano, MD.

Bill writes:

Particularly for Vincent:

Over the many years I have been a TWIV listener, I can’t count the times this topic has come up. Never gets old.


J writes:

I thought you all might like this How the Krebs cycle powers life and death – with Nick Lane