TWiV 1094: Clinical update with Dr. Daniel Griffin

In his weekly clinical update, Dr. Griffin reviews recent statistics on the circulation of respiratory syncytial virus, influenza and SARS-CoV-2 before discussing revised guidelines for how to treat respiratory viral infection guidelines by the CDC, effectiveness of the new SARS-CoV-2 vaccines and the combination of vaccination and antiviral therapy against the development of disease, continues to dispel the myth of viral rebound, how to pay for paxlovid, the lack of evidence supporting ivermectin as an antiviral drug, when to use steroids and the benefits of convalescent plasma, how COVID-19 affects cognitive function and the effect of long COVID and how healthcare works have difficulty making the proper diagnosis for long COVID even using a questionnaire.
Show notes at www.microbe.tv/twiv/twiv-1094/
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[@lesfaby8997]

_KZbin timestamps by Les_ 00:41 Bowtie de Jour 01:29 Quotations (Nietzsche, Daniel's mom) *Stats* 02:01 *RSV* 03:27 *Flu* 04:01 *CoViD* 05:55 CDC released respiratory virus guidance 20:51 Active Vaccination section effectiveness of the new SARS-CoV-2 vaccines (MMWR) www.cdc.gov/mmwr/volumes/73/wr/mm7308a5.htm 27:31 *Early viral phase* 28:11 combined protection of vaccination and nirmatrelvir-ritonavir against hospitalization in adults with covid-19 (CID) academic.oup.com/cid/advance-article/doi/10.1093/cid/ciae105/7614681 31:07 *Cytokine storm* 31:56 *Long CoViD* how COVID-19 affects cognitive function and the effect of long COVID and how healthcare works have difficulty making the proper diagnosis for long COVID even using a questionnaire. 45:48 Please donate 46:03 *Dr D answers your Qs* 46:09 Laurie 47:41 Anna 48:55 office hours - Measle questions / durability of MMR vaccine 50:18 Lori 51:11 Tom see www.microbe.tv/twiv/twiv-1094-letters/ _Audio podcast timestamps by Jolene. Thanks._

[@heathers4449]

Thank you for taking the time to do this week after week ❤

[@lesfaby8997]

@@heathers4449 you are very welcome.

[@LisaMartinez-ri6ve]

Thanks to Jolene and Les

[@user-sp1vx6vz9z]

Sadly, the people who *most* need Daniel's excellent explanations of guidelines are not listening to this podcast. 😢

[@WillNewcomb]

CDC guidance: my take, if people can misinterpret guidance, THEY WILL.

[@Ramiiam]

People aren't buying the COVID booster guidance anymore. They believe their lying eyes.

[@DudeFun-yi7nu]

It must be Saturday morning with Clinical Update at TWiV ... thanks guys

[@4everyoung24]

I used to have to see patients early on Saturday mornings and would listen to the first 10 minutes on the way to the hospital as incentive to go get all the patients seen. Then as my reward I’d get biscuits and gravy in the hospital cafeteria and listen to the rest. I no longer have to round on Saturdays but Clinical Update is still a solid part of my Saturday mornings. Thanks, Drs!

[@annh.8290]

Sadly, the major problem in the USA is most work places people just do not have "Sick days", I worked as a nurse for years, and we only had 3 days sick pay, after that they took away from our vacation days, that might be ok, if one still had those vacation days left. Interestingly, we moved to Europe, and when my husband got sick on vacation, HR told him to send in the days he was sick, and they would give him back those days of vacation, as she put it "you were sick, not relaxing on vacation"!

[@bcase5328]

The guidance is for all illness, not solely covid.

[@emilythechef]

I love Friday night updates. Thanks for your dedication!

[@jact8350]

Thanks. Love listening to updates. I am a non healthcare worker, but appreciate the info and was able to get my family on paxlovid early even when PCM said they were not a canidate (2022). Dr. Griffin you are a gem

[@sampal5352]

Shouldn’t it be about protecting as many people as possible, not ‘satisfying’ everyone? For a virus that is still a complicated, significant threat.

[@Deeppowbro]

Saving the world one podcast at a time

[@WillNewcomb]

Thank you!

[@WillNewcomb]

Good morning. It's day 2 of C19 +ve and feeling a bit rough but I didn't want to m miss daniels update!

[@AzIbra16]

Get well Will

[@WillNewcomb]

@@AzIbra16 Thank you! Blessings!

[@heathers4449]

Feel better soon! ❤

[@WillNewcomb]

@@heathers4449 Thank you!!!

[@doreeno3792]

Feel better Will. Your spirit sounds strong!

[@elizabethmicallef6019]

Love Saturdays w Dr Daniel!❤

[@Tabitha_K]

Daniel is the first American person I’ve ever heard pronounce respir-at-ory correctly! Most people say ‘respitory’. I’m British.

[@bullymaguire632]

Why couldn't they just say N95 instead of a "well-fitting mask", it's clear the other masks don't work

[@petragris1947]

CDC recommendations do not take asymptomatic infection (~40%?) into account. With this guidance, people with asymptomatic infection are free to transmit to others. And people whose immune response has been damaged by prior SARS2 infection(s) may not have acute illness with new infection that rises to the level of notice. Also, nobody but nobody is wearing a mask, not even in healthcare. CDC needs to hit the cardio/neuro/immuno consequences of repeated covid infection. People are just not aware.

[@WillNewcomb]

Q: no viral shedding after 10 days. That would be a usual recommendation, but as we know, health science is never that precise. There will be a range of times. Everyone is different; some shorter, some longer. Can we state what those ranges are?

[@charlieintampa6769]

You are way ahead of me on African countries (I've only been to 3), but I have about 60 some countries and every state at least twice. Even my 16 years old daughter has been to every state :)

[@TE-7302-]

Me thinks Vincent finds the CDC’s guidelines laughable. Nobody is taking precautions.

[@bcase5328]

A mask also helps filter out pollen, so help people with pollen allergies.

[@4everyoung24]

I’m from Texas and we say res-PIIIIIIIIRrruh-tory.

[@ccbowers]

30:50 Latching onto the cardiologist use of "not indicated" misses the actual question. Whether or not to use Paxlovid here depends on opposing risks of holding her antiplatelet due to the DDI vs not receiving the antiviral for COVID. "Chances are she will be fine" either way, until she is not. The idea that the ticagrelor can just be dose reduced is misguided, because the interaction is significant and bleeding is the concern.

[@markgivens3225]

Would be interested in a ‘measles only’ vaccine. Is one available and approved in the US? How commonly available and what do we need to request?

[@gferraro8353]

Prions - yikes @Dr Daniel Griffin

[@traianliviudanciu8665]

At TWiV 659 Christian Drosten suggest that SARS COV2 better replicate at very low tissue temperature. May be If SARS COV2 infection occur must avoid to decrease fever using Tylenol.(even If headache and muscle pain occur) And may be mask wearing not only stop droplets, but also maintain higher mucouseal respiratory temperature.

[@donnamunro2090]

./eyeroll - Why are people using IQ as a measurement anymore?

[@razerginn]

Too funny Respiratory.. I say Toe- may-toe for tamato!😂

[@traianliviudanciu8665]

Did we avoid to decrease lung temperature, If cryoglobuline like antibody occur after SARS COV2 infection ?

[@wednesdayschild3627]

Truth is conformity to reality. Example, it is raining and you put on your coat and boots. Denial is you preten it is sunny and go outside and get wet.

[@janem3575]

my friend got covid in early December 2023. very mild and brief course. she has taste and smell deficits, still. can only detect sweet and salty and spicy

[@Invitational2]

35:01 so does this graph show that ivermectin does indeed work?

[@gribbler1695]

Despite a small benefit in symptom duration, there was no evidence that ivermectin reduced the need for hospital admission.

[@user-vm7kq7po8j]

Nii ei oo mukava juttu eikö nuilla alimittasilla tulfhdusarvoilla ja huippupaineilla on merkitystä

[@traianliviudanciu8665]

Did fever increase interferon action ?

[@juliesharp5077]

*Columbia

[@traianliviudanciu8665]

Did interferon induce high fever ?

[@littlejoe8359]

What is truth ?

[@wednesdayschild3627]

Conformity to reality. Example, it is snowing, you put on a coat and boots so you will not get wet. Denial is you pretend it is sunny, you go out and get soaked.

[@4everyoung24]

@@wednesdayschild3627 Or worse-send your child out without a coat and they get all wet and cold and miserable.

[@graysonric]

Asked Pontius Pilate sarcastically. John 18:38

[@Invitational2]

24:25 they derived this number by comparing those with 7 jabs to those with 8 and concluded 8 had a little better outcome than those with 7. But why not compare those who never took any jabs with those who were octuply jabbed?

[@alowry2002]

Because the purpose is to see the effectiveness of an updated vaccine. So no need to include the unvaccinated. There are lots of studies comparing unvaccinated vs 💉💉.

[@graysonric]

217 jabs are optimum.

[@alowry2002]

@@graysonric only in Germany. 🇩🇪

[@ccbowers]

30:14 Love it. Even antiplatelets get antiviral names on TWIV.

[@TheJamjewel]

💔

[@donnamunro2090]

UmbiLAYcus, crawfish pie, file gumbo

[@Invitational2]

What is this graph saying about ivermectin amongst vaccinated vs unvaccinated at the bottom? 35:06

[@Rene-uz3eb]

I'm starting to think that suppression of P450 enzymes is a reason for the effectiveness of some antivirals in severe cases, not just a side effect. P450 are heme dependent, and can make quite a mess if damaged.

[@traianliviudanciu8665]

Not only interferon induce fever.

[@pdxyadayada]

Why can’t you provide more nuance to your analyses? For example, within what population of individuals does normal exposure to viruses allow for natural immunity to be developed? Also, how might you differentiate which populations (age and health variables) are most at risk of severe outcomes to seasonal virus exposures? And, what explains differences in vaccination protocols between the US and the UK?

[@graysonric]

The time difference.

[@jennycatlike]

your bow tie is another reminder for reasons to not eat animals

[@amiesparkle00]

Prions can also be in soil and crops.

[@Henry-fk7cq]

Plant based foods like sugar, rice, potatoes, grains, some fruits & pasta are driving the metabolic pandemic. Meat, fish, fat & green vegetables are not. Humans are omnivores. Plant based foods are low in certain nutrients & prmote serious diseases.

[@TheJamjewel]

Sigh

[@Invitational2]

35:25 further study unwarranted in vaccinated community? What about the unvaccinated counterpart? Are they saying further studies should be done for this population?

[@Invitational2]

38:38 excellent point. Nice brain gymnastics . Sounds like a study to cover up the vaxx induced brain fog.

[@suekoi3885]

Whether or not vaxxed was not even a factor in this study, only whether or not had Covid.

[@Invitational2]

@@suekoi3885 the vaxxed got Covid too.

[@juliesharp5077]

Just realised Vincent R. also works at Columbia. That totally explains your channel's pro vax stance.

[@wednesdayschild3627]

What does the data say? See video.. we do not know yet if the new booster over 65 helped.

[@juliesharp5077]

​@@wednesdayschild3627removed my other comments I see. Don't you want people to know Columbia University received ten million dollar 3 year grant from Pfizer?

[@suekoi3885]

@@juliesharp5077which of the studies reviewed was done at Columbia?

[@graysonric]

My 97yo father got Covid, probably JN.1, on February 26, exactly four months after he took the 2023-24 booster and I think it helped him. It was his first case and he had mild symptoms and was fever-free without an antipyretic in three days. I stayed in his room every night (on the floor) because I was worried he might need help, but he was okay and I- also frequently boosted; with one prior mild case of Covid, had a a sore throat for two days but never ran fever or tested positive. (I am 73.) Dad would not take the Paxlovid because he thought the side effects would be worse than his mild symptoms. He said if he got sicker on the third or fourth day, he would take it, but by then he felt “over it.”

[@juliesharp5077]

My point was these people work at a university which has received an huge amount of money from Pfizer. Therefore they have a vested interest in telling everybody to get the Vax.