Katie writes:

I recently got COVID-19 and, because I am breastfeeding, I was told by my GP’s nurse that I should not take Paxlovid. I am vaccinated and boosted (but no bivalent booster) and I don’t have any risk factors, so maybe that made sense in my case. Even so, I was laid up for several days and still needed extra rest after a week. (My baby is vaccinated and the viral exposure we both had barely registered a blip on her radar). This experience made me wonder if breastfeeding mothers who *do* have risk factors would be unable to take Paxlovid. What information is out there on the safety of Paxlovid during breastfeeding, and how should clinicians weigh that information? Does the amount that the baby breastfeeds matter? It seems like the advice for an exclusively breastfed infant might be different than for a baby who mostly eats solids and just nurses a couple times a day (as is the case for my baby).


Katie in Virginia 

Dale writes:

Dear Dr. Griffin,

I’m wondering if my son should get the bivalent booster. He’s 19 and has had the standard three doses and had Covid-19 in the late fall of 2021. He is generally healthy, although he has mild asthma that is well controlled. Do any of the new Omicron subvariants necessitate the bivalent booster?



Ellen writes:

Dear Daniel, 

My daughter (who knows I listen to TWIV ‘religiously’) is taking a trip to New Zealand with her 4.5 year-old and a 5 month-old. She asked if she could give the 4 year-old the booster 12 days before travel rather than the full two weeks. No one in the family has ever had covid while taking maximalist precautions. Any advice for traveling with young children would be much appreciated.

Very best wishes for the new year,



Steve writes:

Greetings Dr. Griffin,

My mother is 86 years old and in good health.  She had a semi-annual visit to her primary care physician this week who recommended keeping N-acetyl-cysteine on hand in the event she becomes ill with covid.  I can find a few early reports (2020) suggesting reduced likelihood for hospitalization and ventilation in patients who use NAC.  I am a faithful listener to your TWIV Clinical Updates, but can’t recall you ever mentioning N-acetyl-cysteine.  Nor do I see any recommendations on NAC from the CDC.

I am a bit confused on why a physician would even consider recommending NAC when effective treatments like Paxlovid and Remdesivir are available?  Could you please provide insight and perhaps a reference on this supplement that I could share with my mother and perhaps her PCP?

Thank you.



BTW, I love my Spike T-shirt

Peter writes:

Dr. Griffith, 

As an immunosuppressed person (no B cells after Gazyva/Obinutuzumab for CLL), I thank you for your frequent mentions of these patients, but we don’t get much focused information. My question is: What is your experience treating immunosuppressed patients with Paxlovid and Remdesivir? Is there a preference for one over the other?

Thank you,


Stamford, CT