TWiV 874 COVID-19 Clinical Update #105

This Week in Virology

Host: Vincent Racaniello

Guest: Daniel Griffin

Aired 12 March 2022

pdf of this transcript available (link)


Vincent Racaniello: From MicrobeTV, this is TWiV, This Week in Virology, Episode 874, recorded on March 10th, 2022. I’m Vincent Racaniello and you’re listening to the podcast all about viruses. Joining me today from New York, Daniel Griffin.

Daniel Griffin: Hello, everyone.

VR: Weather’s getting warmer, COVID is dropping, Daniel?

DG: The weather’s working in our favor. Outdoors is a good thing, I think we’ve learned. Things are still moving in the right direction and a lot to cover again today. I was looking through the comments. Last time I warned, I said, “Sorry, this could be a long episode.” A few of the comments were like, “Dan, your episodes are always long.”

VR: Oh, that’s very nice.

DG: Yes. Appreciate the constructive criticism. Let me start with a quotation. “If you will not fight for right when you can easily win without bloodshed, if you will not fight when your victory is sure and not too costly, you may come to the moment when you’ll have to fight with all the odds against you and only a precarious chance of survival. There may even be a worst-case, you may have to fight when there is no hope of victory.” This is Winston Churchill. This is by no means over and certainly, nothing about this pandemic allows us the rights to claim any victory. This has been quite a defeat of humanity by this virus so far.

I’ll be talking a little bit about lessons learned because maybe we’re not going to leave this pandemic without some lessons learned. That’ll be right near the end of this very long episode. I will say that I’m in good moods. Numbers are coming down, less folks in the hospital, even the number of deaths is coming down or we’re not quite to 1,000 deaths per day, but we’re heading in that direction, but I did find a few articles this last week, which were a little disturbing. Let’s talk about those.

The first is SARS-CoV-2 is associated with changes in brain structure in UK Biobank. Now, there’s some great figures and this would be one of those articles that perhaps can be a deep dive on one of our other podcasts like TWiV, for instance, because this does get complicated, rather sophisticated, but let me go through just a high level. Here, the authors investigated brain changes in 785 UK Biobank participants aged 51 to 81 that were imaged twice. Now, what was really exciting about this study was that they included 401 cases who tested positive for infection with SARS-CoV-2 between the two scans. We have a baseline scan, we have a SARS-CoV-2 infection, and then we have a separate scan and we have 384 controls.

They identified significant longitudinal changes when comparing the two groups including, and I’ll go through these, one, a greater reduction in gray matter thickness and tissue contrast in the orbital frontal cortex. That’s an area where there are extensive connections with sensory areas, as well as limbic structures involved in emotion and memory. Also, the parahippocampal gyrus, again, memory and coding and retrieval consistent with some of the reports that we’ve been hearing from patients.

Also, there were changes in regions functionally connected to the primary olfactory cortex. Just potentially another area where we’re seeing damage. We’ve talked about the sustentacular cells, right up there in the olfactory mucosa, but maybe some changes here actually at the cortex level, a greater reduction in global brain size. Then consistent with other reports, the infected participants showed larger cognitive declines between these two-time points.

Concerning impacts on the brain, we also in Open Forum Infectious Disease had the manuscript “New-Onset Dementia Among Survivors of Pneumonia Associated with Severe Acute Respiratory Syndrome Coronavirus 2 Infection.” Here, the investigators reported on 10,403 patients with pneumonia associated with SARS-CoV-2 infection, 3%, so about 1 in 30 developed new-onset dementia basically over the next six months. They just did, they looked at a number of co-founders, but this was consistent throughout, significantly higher chance of going on to develop dementia after SARS-CoV-2. Rather disturbing when we just think about how many people have been infected with SARS-CoV-2.

VR: Daniel, is there any relationship between the brain changes and severity of COVID?

DG: I wish I could say something reassuring and actually what they did is they looked at, well, maybe just people who’ve been sick enough to be in the hospital, let’s compare them to people that didn’t require hospitalization. They saw consistent differences in both populations. Concerning that, even those folks that think of it as a milder form of COVID not requiring hospitalization, they still were seeing these changes. Not good, not good.

I also wanted to briefly address something that really is in our wheelhouse of I’ll say medical communication. COVID in Ukraine. Maybe we have some fans of Guns, Germs, and Steel, the Jared Diamond book which has some flaws, so open to criticism too, but do a very successful disinformation campaign, vaccine confidence in Ukraine has been undermined. According to the WHO, only about one-third of the people in Ukraine are vaccinated. I see these pictures of all these individuals, they’re in these crowded shelters, subways, hiding from the bombs overhead and everyone says, “Well, you’re not thinking about COVID.” Well, I’m thinking about COVID, I’m thinking about tuberculosis, I’m thinking about infectious disease.

Historically, wars have resulted in opportunities for the spread of infections. It’s actually estimated that about 1,000 Ukrainians are dying per week from COVID with the greater than 700 reported COVID deaths per week felt to be a significant underestimation. Without speculation on where the funds for this misinformation campaign originated, there was a report out of a group that was put together at Stanford and they came out with the Virality Project, V-I-R-A-L-I-T-Y. It’s interesting. Virality Project. This was a group, Stanford Internet Observatory, the University of Washington Center for an Informed Public, the Atlantic Council’s Digital Forensic Research Lab, Graphika, The National Conference on Citizenship, NYU Center for Social Media, Tandon School of Engineering.

A lot of people got together and they actually created a report, “Memes, Magnets, and Microchips: Narrative Dynamics Around COVID-19 Vaccines.” Actually, this is a rather lengthy piece that goes into the misinformation, the disinformation because this really was a conscious, targeted malignant. They actually talk a bit about the methods that were used, they identify actors within the US, and foreign actors in China, Russia, and Iran. Really long detail, but really gives a lot of people a sense of where this campaign is being driven from and also a bit about the innocent question tactics that they use. A challenge for us to try to provide reliable science in the face of this well-financed mass disinformation campaign.

Children, COVID, and vulnerable populations. I think it’s very clear now, unfortunately, children are at risk of COVID. I know everyone is done with COVID here in the US, but I have to say, to be honest, I felt physically sick when I looked at the numbers of pediatric deaths for the week ending March 3rd. I was thinking that we would be coming down already at this point, but another 23 children died from COVID-19 that week. We’re still averaging greater than three pediatric deaths per day here in the US. Two dozen children are dying a week from COVID-19. The majority of the deaths have occurred in the last six months. Since the end of the summer, we’ve had an additional 500 pediatric COVID deaths. Actually, Vince, and I shared with you just those numbers where you could see the cumulative child deaths and it’s really disturbing.

VR: I was looking at these numbers today and thinking, “Why would a state like Florida declare that you don’t need to immunize kids when kids are dying?” I just don’t get it.

DG: No, I have to say it’s very disturbing. You look at a vaccine that’s so incredibly safe, and maybe we’ll even go into how safe it is, and the idea that you would not protect our most vulnerable. There’s got to be some political advantage to that agenda. Disturbing, because the science is very clearly, when you’re making a decision, that decision to get a child vaccinated is a much safer decision than– As we’ve seen, about half of our kids under 18 have been infected with all that comes with that. Now we’re looking at potentially long-term neurological damage, et cetera, just a tragedy.

Actually, that you mentioned that, just announced Wednesday, November 9th, Pfizer initiated a phase 2/3 study of their novel COVID-19 oral treatment in pediatric participants. This is PAXLOVID, or Nirmatrelvir. This will be the EPIC-Peds trial, and they are going to evaluate the safety, pharmacokinetics, and efficacy of Pfizer’s oral antiviral. They’re going to be doing a phase 2/3 open-label multicenter singer-armed study in approximately 140 pediatric participants. They actually acknowledged right up front that this is a pressing need. 11 million children under the age of 18 in the US have already tested positive for COVID-19, there’s been more than 100,000 hospital admissions for these children.

As we share, we’re approaching 1,000 deaths with most of those just in the last six months. They’re going to go ahead and hopefully, we’re going to get some information, there’s going to be two different cohorts. Cohort one is going to be pediatric patients 12 and up. Cohort two is actually going to be a second dosing strategy, so a lower dosing strategy. This is going to be twice a day for five days. They actually did mention too, they are going to try to go down even lower to get us information about younger age groups, so another potential option that we might have for our children.

Again, nothing is as good as the vaccinations here. All right, testing. Never miss an opportunity to test. We need to remember that this is still out there. One of the things I will comment about here is with the growing number of home tests. I’m getting lots of calls, calls on a regular basis where people have tested at home, they’re positive, they want guidance. This is not being entered into those prevalence estimates. When you see your map of how many new diagnoses per 100,000, we’re getting a growing number of positives that are, so to speak, off the radar.

Just important for us to keep in mind the decreasing reliability of those status updates. All right, the pre-exposure period, the non-pharmaceutical interventions, masks, reducing exposures, spending time outdoors. The MMWR early release SARS-Cov-2 incidents in K-12 school districts with mask required versus mask optional policies, Arkansas, August through October 2021. Here in Arkansas, when they compared places that had universal mask requirements compared to those that did not, those with universal mask requirements reported about a 23% lower incidence of COVID-19 among staff members and students.

Couple of comments here, 23%, that’s not huge. I know a lot of parents are really concerned now that the masks have come off, a few comments, the sky is not falling, this is not our most powerful intervention. With case numbers dropping, being in school now with a mask off with lower prevalence is safer than it probably was with a mask on back when we had really high prevalence. Just a growing amount of data here. Masks have a benefit. It’s not huge and we’ve talked a bit about that. Next, I think this is really an interesting, and again, I’m going to say, Vincent, we need to have “this week in genetics.”

I mean, I spent a little time doing genetics research so I felt comfortable with this paper, brought back some bad memories. “The Whole-Genome Sequencing Reveals Host Factors Underlying Critical COVID-19” published in Nature. In this investigation, with a long list of authors, they performed whole-genome sequencing in 7,491 critically ill cases and 48,400 controls. Can you just imagine the budget on this study with whole-genome sequence of this, like 57,000 patients? They actually were able to identify several associations, including variants within genes involved in interferon signaling, leukocyte differentiation, blood type antigen secretor status, myeloid cell adhesion, and coagulation factor FVIII.

Then they actually go on to say that a lot of these variants are potentially druggable targets. The whole idea here is potentially you would be able to identify those people that are high risk of progressing to severe disease, because this comes up all the time. People always say, “I don’t understand, 10 people get infected, and then this one person gets really sick, and these other people, they do so much better. What is going on?”

This is really getting at really scientifically, it’s the genetics. We really are finding a nice number of mechanisms here and the mechanisms are involved in these individuals having a failure to control viral replication, an increased tendency towards the pulmonary inflammation, and an enhanced tendency towards intravascular coagulation. It’s a fun paper, it’s got the Manhattan plots. What’s actually really great in this paper is they actually have these predicted structural consequences to the identified changes, so really a great paper to take a deep dive into.

VR: With respect to this week in genetics, I hear that Eric Lander has some time, maybe he’d be interested.

DG: That would be great, that would be excellent. Does he actually have time? He’s a busy guy.

VR: He was just fired by the White House, right?

DG: [laughs] All right, I feel like we got a little close to politics on that one, so we’ll stand back. Don’t invite him on the show. All right, active vaccination, never miss an opportunity to vaccinate. Reports that we may be getting closer with Novavax. I’m positive, I know people are not always as positive as I am, bucket full of sunshine over here, my nickname. There are certain people who are hesitant to get vaccinated with what are perceived to be newer technology vaccines. The Novavax is this traditional protein-based just like your shingles shot, just like some of our other shots that we’ve had for many, many years.

They’ve resolved their manufacturing issues, there may be some new data required to be submitted from Mexico, we’ll see. The current estimate is that May is when we’ll have this as another option. Remember, vaccines, you need a little time. This isn’t like a mask you can put right on, this isn’t just like that decision not to go to that crowded restaurant. You got to get vaccinated, you got to get your first shot, you got to get your second shot, maybe you’re getting a third shot. You got to start moving in this direction, because we are expecting numbers to increase come next winter when it settles into more of a seasonal pattern.

Hopefully this spring, we’ll have another option out there. Evusheld, I’m going to talk a little bit about Evusheld here but I’m also going to mention a little bit later. A little venting here, I’m going to vent Vincent. Roughly 80% of the available doses of Evusheld are sitting unused in warehouses on pharmacy and hospital shelves. What’s going on? Many patients and providers are not aware of this option. The states are not ordering their doses of the 1.7 million doses that have already been paid for, purchased, and raised for distribution. Only 370,000 doses have been ordered by the states.

There’s also there’s bureaucracy here. I’ll say our organization which is becoming an Optum Tri-State, thousands of providers, we’re trying to get access so we can give this to our patients in the comfort of the offices provided by trusted providers, clinicians that they have relationships with. A couple of our oncology groups have their administrative folks working on this. We have yet to get access to this drug. We’re still reliant on our partner organizations to access this therapy for our patients. We need to do better for those immunocompromised folks who can’t get the benefit of active vaccination to provide them with this passive vaccine option.

The period of detectable viral replication. This is when you test positive, the time for monitoring monoclonals, anti-virals in a moment in clinical trials. There is a little bit of a political aspect here. We may be running out of money to provide these treatments for free paid for by the government unless something changes here in the US. The current supply of monoclonals will run out by May. Stocks of oral antivirals will also be depleted. We might have enough to last us until September. My fingers are crossed that they’ll work out things down there in DC and get funding for this.

Here we are in, I’m going to say another encouraging re-assuring paper, “Efficacy of Antiviral Agents Against the SARS-CoV-2 Omicron Sub-variant BA.2”. We’ve talked a little bit about this as the stealth variant. This has been increasing across the country, here in the US greater than 10% of cases. You go a little bit Northeast of us it’s a quarter of all cases right here in New York, it’s clearly above 10% West Coast, et cetera. Most for our country, this is actually becoming an issue.

They did report in this correspondence published in The New England Journal of Medicine that’s susceptibilities to Remdesivir, Molnupiravir, Nirmatrelvir so all our direct-acting antivirals were similar to those of the ancestral. They say straight, I’m going to say variant and other variants of concern, but some several as we’ve talked about of the therapeutic monoclonal antibodies had lower neutralizing activity against Omicron BA.2 but re-assuring that Cilgavimab, that’s one of the two monoclonals in Evusheld, actually looked really good but they also did show that there might be some impact on Sotrovimab.

Let’s go through. Number one choice, person test positive, you ask the question are you high risk? Are you going to be eligible for therapy? It’s a sore point for a lot of people because no one is at low risk of long COVID, but we really have not reached beyond that high-risk group for hospitalization and death yet. PAXLOVID the supply relative to demand is improving. I have to say speaking in our immediate area, we tend to be doing well but I know some of my colleagues across the country are struggling to get access for their patients. There’s an educational component that is standing in the way here as well.

The next option is monoclonal therapy. As I was starting to mention in the US, the BA.2 the stealth variant of Omicron has reached more than 10% and this calls into question the efficacy of Sotrovimab, and we’ve discussed conflicting data out of Columbia, NYU, and now what I just discussed suggesting that there may be some negative impact on Sotrovimab but some data from GSK where they felt like there still was continued efficacy. Here I’m going to say Connecticut and Northeast of us about 24% BA.2. Region 2 that’s here, New York, New Jersey, 17%.

We have a good supply of Bebtelovimab, and I think we’re all in agreement that this remains effective but there’s a couple of little things here. One I’m going to say the EUA requires that we are in the first 7 days, not 10. I have to say I think that makes sense for all the monoclonals once you get out today 8, 9, and 10 I’m not sure you’re getting much benefits. Really that first five to seven days. Really the first three to five is the most effective as we’ve seen.

I have to say at least locally today I was communicating with Stefan Muehlbauer he’s another MD PhD. He’s head of the ER over at Saint Francis, one of the Catholic health system hospitals. He has been a great partner over the last two years and what we do is for our patients preferentially they just get Bebtelovimab. The dosage of Bebtelovimab is a little bit interesting. It’s by short IV push.

Let me go through Bebtelovimab. The dose, and this is for high-risk adults 18 years and older or pediatric patients 12 years of age and older got to weigh at least 40 kilograms, 175 milligrams. It’s intravenous injection over 30 seconds or more. It goes in pretty quick. These aren’t those 20, 30-minute infusions anymore. You want to give it within those seven days as I mentioned and it’s very easy to work with. It sits in the refrigerator, it’s 2 milliliters in a vial, it comes out 20 minutes to get to room temperature, and then you go and give those 2 milliliters IV. A little bit easier to get at there. You still have to keep an eye on them and make sure they tolerate it.

Remdesivir is our next option. A little bit more challenging. That three-day IV 200 upfront and then 100 and then Molnupiravir. I’ll say it’s at the bottom of the list, but it’s a nice option. We don’t have to worry about kidney function, we don’t have to worry about drug interactions, and still about a 30% reduction in progression. Next, we’ve failed a little bit. The person has moved into that early inflammatory phase. No big changes here, still steroids at the right time in the right patient, anticoagulation at the right dose in the right patient. If they end up in the hospital, pulmonary support maybe escalation to more immunomodulation.

Now, we will move to the tail phase, long COVID, post-COVID. At first, I want to start off with discharge. The patients ended up in the hospital, now it’s time to send them home, what do we do? What do we do at that point? Now, most people don’t end up in the hospital. For those that do, what do we do about steroids? As we’ve gotten I’ll say a little bit better about trying to get these folks home a little quicker. Maybe if they’re on Remdesivir for five days, after day three we might finish that off at home. We might provide oxygen in the home, but a lot of folks are actually quite better at discharge. They’re off oxygen, do we continue those steroids? That’s a big question.

We’ve already said according to most of the guidelines, we go ahead and stop anticoagulation unless there are compelling reasons, but the study association between dexamethasone treatment after hospital discharge for patients with COVID-19 infection and rates of hospital readmission and mortality was published in JAMA.

They reported in a cohort of 1,164 patients with COVID-19 who received less than 10 days of dexamethasone so they’re getting 6 milligrams per day, now it’s time to discharge them. They compared those that were discharged to finish off versus those that just stopped when they left the hospital. They found no significant difference as far as rates of readmission, mortality, or really much else. This is really in line with what a lot of us are doing. If the person gets better quick and they’re able to get out of the hospital early, in most cases, we’re stopping anticoagulation, we’re stopping steroids, we’re sending them on their way.

Now, I have to say, Vincent, I was envisioning this would be the growing part of our episodes as we had trials to get people into and all these different treatment options for this growing group of folks suffering from long COVID, but I think we’re still at the phase unfortunately where people are really resistant to the fact that this exists. People don’t want this to be true.

We’re still getting papers confirming that this is a thing. The paper, “Post-Acute Symptoms, Nuances Diagnosis, and Health Problems 6 to 12 Months After SARS-Cov-2 Infection: A Nationwide Questionnaire Study in the Adult Danish Population,” was recently posted as a pre-print. As you can see I’m getting away a little bit from the pre-prints.

This is actually one of the largest studies and this is in line with a prior publication we’ve talked about. “Risk of Clinical Sequelae After the Acute Phase of SARS-Cov-2 Infection: Retrospective Cohort Study,” published in the BMJ by some of my colleagues at UHG and OptumLabs. In this preprint that was posted the researchers did a nationwide cross-section study including 152,880 individuals aged 15 years or older with PCR confirmed SARS-CoV-2.

Then they actually compared this to a test negative control group, 91,878. Data was collected at 6, 9, and 12 months. At 6 to 12 months after the test date, one-third, so about 30% of the test positive experienced at least one physical post-acute symptom. We had dysosmia, so things are not smelling right. We had dysgeusia, things are not tasting right, fatigue, exhaustion, dyspnea, trouble breathing, reduced strength in arms and legs, and more than half of the test positives reported at least one of the following had cognitive issues, concentration difficulties, memory issues, sleep problems, mental or physical exhaustion. Really seeing a lot of continuing evidence that this is a thing, I will say.

VR: Daniel, what do you think about these questionnaires? Can’t we have diagnostic tests for long COVID that would be more solid data? I understand this but a lot of people have similar issues but it’s not long COVID, right?

DG: Yes. Vincent, I think we need that. We need it for several reasons. We do need some objective tests to assist these people to identify to confirm that it’s not in their head because there still is a lot of dismissiveness. That was nice about the study we talked about last week where there were actually biopsy confirmed changes. Now we’re seeing the imaging confirmed changes. It’s challenging, it’s not a lot of people don’t have a baseline imaging that we can then say, oh look, we’ve seen this reduction. We do. We need some objective, we need to move past questionnaires. It’s true, when I try to help these people and I get on the phone with a disability person, they say, well, they’re just telling you this. Maybe they’re just not being honest with you. Do you have anything objective to support their story? We need that actually, that’s really critical. It’s even critical I think for the studies, if we can identify something objective, we can make sure we’re studying the right populations.

VR: Exactly. Right. If we had, this may not be it, but cytokine levels, ratios, or something that you could say, ah, this is long COVID. Right?

DG: Yes. All right. The rest of the world, no one is safe until everyone is safe. Couple bits of, I’ll say good news here. There are plans for a Moderna mRNA vaccine factory in Kenya. We also heard that six African countries will start producing COVID mRNA vaccines as part of a WHO technology-sharing program. Then I am going to close this out with a new section, I’m adding a new section, lessons learned. This I thought was an exciting last week, the global pandemic preparedness summit was held in London and it was March 7th and 8th. At the end of this meeting, there was a pledge, they concluded with a pledge to provide $1.535 billion to CEPI. CEPI is the Coalition for Epidemic Preparedness Innovations. Their scientific advisory committee is really a who’s who in the field.

I can recommend TWiV 612, where Vincent spoke with Richard Hatchett, the CEO of CEPI. Look through like go to this website, go to and just look at all the people, tremendous people that are involved in this effort. This really goes back to my Churchill comment. This pandemic has been devastating in terms of loss of human life, devastating in terms of economics. Really devastating in so many levels, even beyond just the direct impacts of COVID, the direct impact on global and all kinds of other health systems throughout the world. This is putting an ounce of prevention in front of those trillions of dollars of cure that we had to bring by not being prepared. Really positive I have to say to hear this news.

As I close as this drops, so we’re recording Thursday night, this will drop maybe on Saturday morning, it’s off to Vincent. One thing, when it drops it’s going to drop on the 12th of March, but the 11th. That’s tomorrow after we’re recording this that was one year, two years, two years after this was acknowledged officially as a pandemic. Really a tough last two years. When a lot of people listen, I’m going to be on a plane headed down to Panama where I’m going to be headed out to a remote community to provide medical care in a mobile clinic that we will set up in this community. When we record our TWiV next week I will share my experience down there. I’ll share my experience about the pandemic’s impact on this very limited resource region. At this point I want everyone to pause their recording.

I want them to go to click the donate button. Every small amount helps us to continue doing what we’re going to do. We’re going to be here next winter when case numbers start going up again so you have a reliable source of information. Right now during the months of February, March, and April donations made to Parasites Without Borders will be matched and doubled up to a potential donation of $40,000 to the American Society of Tropical Medicine and Hygiene. Included in these funds, will be scholarships for the annual meeting travel awards for the 2022 meeting in Seattle Washington, and priority for the scholarships will be placed on females from low- and middle-income countries who might not otherwise be able to attend.

VR: Time for some questions for Daniel. You can send yours to Dominic writes, “Your podcasts have been very helpful. Once the pandemic is over, would it be possible for you to do a monthly podcast to cover clinical aspects of a chosen infectious disease? Microbe TV is fantastic, but often it focuses on details that my 80 to 90 workweek doesn’t permit. You could bring in hardcore research in a manner that is more clinically relevant and have Vincent ask the critical questions that reinforce the scientific nature of the podcast. Thank you, Dr. Griffin, for bringing material that helps my patients, and you Dr. Racaniello for creating a hardcore research forum that has been sorely needed.”

DG: This is perfect, this is like a plug, Vincent, for next month. We’ll announce it now. We’re going to be resurrecting the puscast. I don’t know if our listeners are familiar with Mark Crislip’s podcast, Persiflagers puscast. He stopped doing it. We reached out to Mark and he has asked us to– well, allow us to pick up the reins. Sara, who people may remember Sara Dong from Febrile, another podcast. She was on This Week in Parasitism.

Starting next month, once a month Sara and I, and Vincent’s going to be involved as well are going to be going through the new scientific infectious disease literature, really targeting clinicians. Then we’re going to make sure each month we take one of those articles and do a little bit of a deeper dive into what’s the current area. Yes, we are going to answer this email with a new podcast, a resurrected podcast, which will fire up in April.

VR: Lisa writes, “I’m a pediatric nurse practitioner who lives in Southwest Florida. It’s not been the easiest place for those of us who believe in science to ride out this pandemic. A recent weekend visit to New York City was like a refreshing trip to another planet. One in which masks and vaccines were not only encouraged but required and where it was easy to stop on a street corner for a COVID test. A few days ago, our governor berated some high school students standing behind him at a press conference for wearing masks.

He asked not in the nicest tone of voice these students to remove them saying masks were ridiculous in COVID theater. Today I read that our surgeon general is going to recommend against COVID vaccines for healthy pediatric patients. I’m curious as to your thoughts on these actions by our state leaders. Yes, that is a flippant question as my guess is you find them as frustratingly ridiculous as I do. Thanks for all the work you do.”

DG: Yes. I saw that video, Vincent, I don’t know if you watched that interaction. I was bothered by it, I try to keep my opinions out of this. I try to provide education knowledge so that people can make their own decisions. I really try to respect the decisions that parents and their children make together. What I’m surprised by this is there’s always this rhetoric about freedom, let people make their own choices. When those kids went to school that morning, I’m assuming there was a discussion with the parents.

That decision to wear the mask or not is that child’s, it’s their parents, it’s their family’s decision. I thought that that was upsetting, that dynamic there. I’m certainly upset with recommendations that go contrary to the science and that don’t actually involve the best education, the best science, the best recommendations for our children.

VR: Erica writes, “I’m a medical practitioner in Australia, fully vaccinated and boosted. I’ve heard of a few medical colleagues refusing to be vaccinated because of their concern about the mRNA vaccine causing subclinical and ongoing myocardial scarring, leading to increased risk of cardiac morbidity and death. Are you able to discuss the risk of this complication, please?”

DG: Yes, no, certainly. Really, as I think has been clearly borne out, you are making a decision to either get vaccinated or to get infected. Getting vaccinated your risk of cardiac damage is so much lower. Logs lower, getting infected you’re actually talking about a real risk of cardiac scarring, a risk of pulmonary scarring, a risk of neurological impact, a risk of death, hospitalization, long COVID. Yes. Getting infected is not the safe option in any context.

VR: Finally, from Roy, “Thank you for your clinical update, they’re amazing. My mother, 78 years old has multiple comorbidities from six to nine, depending on how one counts them. I’ve been very careful with her for the past two years, physical distancing, mask, outdoor ventilation, HEPA filters, et cetera. She’s fully vaccinated, including all other vaccinations. Now people are speaking of normal life. How can I protect her? Should I protect her? What is her risk if she goes back to completely normal socialization? I.e., no mask, no ventilation, no physical distance.”

DG: Yes. This is tough, right? When people get up and they say, “Hey, be reassured those people that are dying after vaccination, they’re old, they’ve got multiple comorbidities.” You’re sitting here like I am with people I care about saying, “Well, I’m not okay with that.” The big thing that we can recommend right up front is EvuSheld. If this is an individual who may not be able to get that protection from active vaccination, look into whether or not they qualify. It sounds like this person is a high-risk individual who might actually qualify for that.

Then it’s going to continue to be smart decisions about wearing masks that protect them, making decisions about when it’s appropriate or safe or makes the right risk-benefit to dine indoors versus dining outdoors. For the last two years we’ve actually been I’d say nice as a society to individuals that are higher risk and now we’ve decided that we’re done with that.

I know this is challenging, but go ahead, talk to the physician what are the different things that might be helpful, and then know about access to therapy. If your loved one gets sick, tests positive know how do they access that PAXLOVID.

What medicines are they on that might be a problem, what’s their kidney function? Maybe monoclonals is a choice as well. We do have tools and I think that’s really important to have that discussion so this person can have the best potential outcome should they have infection.

VR: That’s COVID-19 clinical update number 105 with Dr. Daniel Griffin. Thank you, Daniel.

DG: Oh thank you so much, and everyone be safe.


[00:41:47] [END OF AUDIO]

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