Christiane writes:

Dear Twiv,

My question is about a friend who is a 84 year old female. Last year she was diagnosed with polymyalgia rheumatica. She has been treated with corticosteroids since and her doctor has now decreased the doses gradually to get her off this medicine soon.

She never had COVID and has been fully vaccinated and boosted. Last September she went for a Moderna bivariant booster shot. She has never had an allergic reaction before to any kind of vaccine. But this time she had a huge and painful skin rash that led her to the ER and has been successfully treated with steroids. The Public health department has referred her to an allergy specialist, who can’t see her until next January.

In the meantime she has decided on her own not to take the flu vaccine this year. I am not sure if she had any recommendation about that by the Public health department. Considering she is a 84 years old lady, immunosuppressed by the corticosteroids treatment she went through, do you think it is a wise decision not to take the flu shot ?

Thank you for your precious help,


Susan writes:

Dear Dr. Griffin, Vincent (and the rest of the TWIV gang):

I am a Primary Care Nurse Practitioner working in the London Ontario area, in a Family Physician office.  I discovered your podcast at the start of the covid 19 pandemic and I have relied on your Clinical updates as my anchor for best clinical evidence to share with my patients and Physician/NP colleagues. I have shared your podcast with everyone in my circle of influence. I am deeply appreciative of all TWIV podcasts. I wonder if I am not a Virologist at heart, (but I never had that opportunity within my family of origin). I owe TWIV a cheque of financial support for my debt of gratitude and I will bring it by when I am in NYC next (my son lives in Manhattan).

Our local tertiary hospital is LHSC (London Health Sciences Centre) and the Medical Chief of one department (not to be named) is advising staff to get the Pfizer bivalent vaccine over the Moderna bivalent vaccine due to its target against BA4/BA5. I have always heard you say Moderna provides better immune protection over Pfizer. I believe Dr Griffin you have had Moderna vaccines yourself. I had the Moderna bivalent vaccine. Would you please clarify this Chief of Medicine’s statement. I have colleagues that are now reaching out to me asking to explain this Physician’s thinking. My hunch is that the Moderna is still the vaccine to get.

Deepest gratitude for your highest standard for clinical and virology information, that is so deeply needed in this era of medical misinformation.



Nikki writes:

Can you please discuss the discontinuation of statins prior to Paxlovid use? Are  lovastatin and simvastatin the only statins that are contraindicated and why? How concerned should I be about my elderly parents having an adverse reaction if they were prescribed Paxlovid along with a statin?

Thank you,


David writes:

Here’s a mnemonic for the ER folk. 

A one-T POTS should drink some soup. 

A two-T Potts may start to stoop.

But I will bet my silk culottes

There isn’t any three-T POTTTS.

Thanks for your ongoing work.  I listen every Saturday. 

David A. Clements MD
Carolina Internal Medicine
Asheville, NC