AARP Coronavirus Tele-Town Hall: October 21, 2021

Bill Walsh: Hello. I am AARP Vice President Bill Walsh, and I want to welcome you to this important discussion about the coronavirus. Before we begin, if you'd like to hear this telephone town hall in Spanish, press * zero on your telephone keypad.

AARP, a nonprofit, nonpartisan membership organization, has been working to promote the health and well-being of older Americans for more than 60 years. And the face of the global coronavirus pandemic, AARP is providing information and resources to help older adults and those caring for them. The past week has brought a wave of good news on the COVID-19 vaccine booster, shots and treatments, but it has also prompted a lot of questions about who is eligible and when. Across the country, the number of new cases of COVID continues to trend steadily downward, which is welcome news.

However, it's a different story in the nation's nursing homes, where we've seen an uptick in new cases and COVID-related deaths. Today we'll hear from an impressive panel of experts on these issues and more. If you've participated in one of our tele-town halls before, you know this is similar to a radio talk show, and you have the opportunity to ask your questions live.

For those of you joining us on the phone, if you'd like to ask a question about the pandemic press * 3 on your telephone to be connected with an AARP staff member who will note your name and question and place you in a queue to ask that question live. If you're joining on Facebook or YouTube, you can post your question in the comments section.

We have some outstanding guests joining us today, including an infectious disease expert and another on family caregiving. We'll also be joined by my AARP colleague Mike Watson, who will help facilitate your calls today. This event is being recorded and you can access the recording at aarp.org/coronavirus.

Now I'd like to welcome our guests. Katie Passaretti, M.D., is the chief epidemiologist at Atrium Health in the Southeast.

Welcome to the program, Dr. Passaretti.

Katie Passaretti: Thank you.

Bill Walsh: All right. And our other guest is Lori Smetanka. Lori is the executive director of the National Consumer Voice for Quality Long-Term Care. Welcome back to the program, Lori.

Lori Smetanka: Thanks, Bill. Glad to be here.

Bill Walsh: Let's go ahead and get started with the discussion. Dr. Passaretti, let's begin with you. I know our listeners have a lot of questions on booster shots. Would you mind reviewing the basics for us and the developments this week? Who is eligible? Can you mix brands? And of course, there's a booster for the Pfizer vaccine. Is there a booster for J& J and Moderna nearing approval?

Katie Passaretti: Great questions. It's been a couple of weeks of kind of evolving information. Just to level set first, I want to draw the distinction between third doses for people that are moderately or severely immunocompromised, which are intended to get those individuals whose immune system protection is lower to the same level of protection as someone with a quote-unquote normal immune system. And that has been approved for both Pfizer and Moderna. When we're talking about boosters, we're talking about broader use of an additional dose of vaccine, because over time, the protection from the vaccine has decreased somewhat. So what is currently approved is if you were initially fully vaccinated with Pfizer, both doses, at least six months out, and considered high risk.

So the recommended to get the booster are individuals, all individuals over the age of 65, and then anyone between 50 and 65 that have other medical problems it's recommended. And people that can consider a booster within the current recommendations are those 18 to 50, again, with other medical conditions, which may be diabetes, obesity, the usual kind of things that we've heard throughout the pandemic, or individuals that are at high risk for exposure due to occupation or institutional settings. So like health care workers like myself     can go ahead and get a booster. So the current discussion, and I will say the CDC and ACIP, which is the group of scientists that weigh in in the U.S. on immunization recommendations, are meeting as we speak about Moderna, Johnson and Johnson, and whether we can mix and match different types of vaccines.

The FDA vaccine advisory group met over the past week, and their recommendation that will be considered by the ACIP and CDC for Moderna is essentially exactly what I said for Pfizer. So more than six months out, it's high risk group, reasonable to get a booster to boost up that level of protection. Johnson and Johnson, it appears that the recommendations are going to be different. And that's reflecting that Johnson and Johnson at baseline has a little bit lower effectiveness in preventing illness from COVID. So for that particular vaccine, what the FDA has approved is for anyone, not just high risk, that got Johnson and Johnson, if you're more than two months out from getting Johnson and Johnson, consider getting a booster to boost up that level of protection.

The other kind of burning question on everyone's mind is can we mix and match different vaccines? So all of the vaccines have primarily been studied in isolation, right? So Pfizer, Pfizer; Moderna with Moderna. We are starting to get a hint of data, both from Europe and from a recently released NIH study, suggesting that, one, there isn't harm associated with mixing and matching vaccines. And two, in some cases specifically if you got the Johnson and Johnson type of vaccine, there may be actually extra protection offered by getting at mRNA — so that’s Pfizer or Moderna. So that data is very early. It'll be interesting to see what the CDC recommends. The FDA has opened the door to more mixing and matching.

So, that's the piece that will be interesting to see where the CDC comes out at the end of today. I suspect they will also say it's reasonable to consider mixing and matching vaccines, but we have to stay tuned to see what the official recommendations are.

Bill Walsh: A lot more to come on that front. Thanks very much for that, Dr. Passaretti. And let me follow up quickly. So if you're fully vaccinated with a booster, can you still carry and spread the virus? I asked because I'm wondering in what circumstances it's necessary to mask or social distance if you've been vaccinated and gotten a booster, and we've all seen large crowds at public and entertainment events.

Is this a cause for concern, given that a core of the country still isn't vaccinated?

Katie Passaretti: Yeah, so vaccines are amazing. They have saved millions and millions of lives, but they are not perfect. So yes, someone that is fully vaccinated, even with a booster, could potentially carry and spread the virus. Having said that, your risk of getting infected, the length of time that you are able to spread the virus is much lower if you are vaccinated. And Pfizer actually just came out today with data that showed a 95 percent protection against any infection if you get a booster. So that booster bumps up your level of protection, the vaccines are great at baseline at kind of decreasing that risk in general, decreasing the risk of you getting infected and spreading to other people, and that booster helps get that higher. I do think we are, fortunately, as you mentioned, decreasing in cases. The level of community burden is coming down after this very kind of hard, hard surge from delta over the past couple of months, but as we get boosters and higher levels of just baseline vaccination in our communities, and that amount of community cases come down, things like larger events, particularly outdoors, become less risky. So I think we're headed toward a better area. I think for many people boosters can help prevent that spread and are a good thing moving forward.

Bill Walsh: Very good. Thank you very much. Now Lori, let's turn to you. We just heard Dr. Passaretti talk about a steadily downward trend in new cases, but that's not the same story in the nation’s nursing homes. … We've seen the number of nursing home deaths from COVID almost double in September. What's causing that spike?

Lori Smetanka: Sure. The numbers between July and September have increased significantly — almost 400 percent in terms of cases, and higher numbers with respect to deaths, too. And we know that the increase is primarily due as a result of the delta variant, but contributing to that is the low vaccination rates among staff and others that are bringing it into facilities, where then it spreads quickly among the staff and the residents.

This population continues to be very vulnerable to COVID, and the spread in the setting is so alarming because how vulnerable they can be. Fortunately, nearly 90 percent of residents have been vaccinated, but many are susceptible to the breakthrough infections. And so that's obviously been a really big problem.

Another piece of it is that as the numbers increase, it's important to point out that the COVID increases … it's not just the COVID cases, but it also affects the ability of residents to receive visits from family and friends, their ability to participate in group activities, meals in the dining room and more. And so it really leads to isolation of residents, and the impact of that, that we've seen over the last year and a half, has been significant on residents’ physical and mental health. So we really want to ensure that we get those numbers down again.     The biggest factor that's helped protect residents has been the vaccine, so we are strongly encouraging all staff, residents, families, anyone entering a nursing home to be vaccinated and ensure that proper infection prevention protocols are being followed.

Bill Walsh: Well, let me dig into that a little bit. You were talking about the vaccination rates among nursing home staff. And right now it's at about 65 percent nationwide. Now some states have mandated vaccines for nursing home staff, but others have passed legislation that bans employers from requiring vaccines. For families, this can be really confusing. What questions should families ask if they have a loved one in a nursing home and what information should they expect to get?

And, and what about assisted living? I mean, we don't have the same visibility into assisted living facilities as we do into nursing homes, do we?

Lori Smetanka: Right. Absolutely. It's definitely confusing for families with all of the different rules, the different mandates and timelines that's happening out there. So it is important to pay attention to what's happening in your state and know what the rules are, but also to know what's happening in your nursing home or your loved ones’ nursing homes.

So for any long-term care facility, this includes nursing homes or assisted living facilities, we would encourage residents and families to ask questions about the vaccination rates of residents and staff. While they won't give you personal information about who is and who is not vaccinated, they should tell you with no problem what the percentage is of the residents and staff that are vaccinated.

And as I mentioned, close to 90 percent of residents, and you've noted that more than 65 percent of staff, have been vaccinated so far.

They should also be asking facilities what they're doing to encourage and supporting their staff to get vaccinated, ensuring that all new residents coming into the facility are vaccinated or have access to vaccines, and how they're working to protect residents from the spread of COVID. Do they have in place their policies and procedures that have to be followed by everyone that comes into the facility to prevent the spread of COVID? Are they ensuring that they're being followed? Are staff being trained appropriately, and are they providing information to residents and families about that? There's no excuse at this point for the staff and others not to have the information they need or to be trained properly in infection prevention protocols.

The other thing to remember is that … the federal government is also posting vaccination rates on its care compare website, which is where you can get information about nursing homes. And that website is medicare.gov. And you can click on their care compare site and get information, and you can get the actual vaccination rates for staff and residents in nursing homes on that site. For assisted living it's more dependent on what information the state provides, and so you can certainly ask your nursing home or contact your state's department of health for more information about that.

But we're seeing mandates come down in some states for workers to be vaccinated. We're seeing many employers as you know, both health care providers as well as other employers, that are requiring workers to be vaccinated. And the federal government has issued a mandate, and we're waiting for more information about that and its implementation to come soon.

Bill Walsh: Very good. Thank you, Lori. Some terrific advice there.

We're going to get to those live questions shortly, but before we do, I want to bring in Megan O'Reilly. Megan is the vice president of health and family and government affairs at AARP. Welcome, Megan.

Megan O'Reilly: Delighted to be here, Bill.

Bill Walsh: In addition to sharing the most current coronavirus information, we'd like to take a few minutes to update our listeners on important issues facing Congress. Megan, thanks for joining us today. What can you tell us about what AARP is fighting for right now that will help older Americans?

Megan O'Reilly: Thanks Bill. You know, our fight to lower prescription drug prices continues to be one of our biggest priorities. We are urging Congress to allow Medicare to negotiate drug prices with pharmaceutical companies, despite nationwide ads that the drug companies are running that say it would limit choice for consumers. Medicare negotiation would actually maintain choice and dramatically lower the price of life-saving medications, which would benefit all Americans. We're also fighting to have dental, hearing and vision benefits added to Medicare's coverage.

Bill Walsh: Well, that would be great. And in addition to Medicare, AARP fights to protect Social Security. There's been some news on Social Security this week, hasn't there?.

Megan O'Reilly: Yes. Congress recently announced that highest Social Security cost of living increase in 40 years. Those receiving Social Security benefits will receive a 5.9 percent boost to checks next year, an average of about $92 a month. This will greatly help older and disabled Americans keep up with rising prices.

Bill Walsh: That's fantastic news.

Megan O'Reilly: It is. Many retirees tell us that what they pay at the grocery store or for utilities or prescription drugs is going up much faster than their Social Security checks can cover. These cost of living increases are crucial to help keep up with these rising costs. That being said, we also need to strengthen and protect Social Security for the long term, so that those who paid into the program over their working lives can count on getting the benefits they have earned.

Bill Walsh: Now, today we've been learning more about the crisis that's still facing nursing homes in the face of COVID-19. Tragically, there've been more than 2,000 nursing home residents’ deaths just in the past month alone. What's  happening there?

Megan O'Reilly: COVID continues to ravage nursing homes across the country. We seeing far too many infections and deaths in these facilities. AARP is leading the way in analyzing and reporting how COVID impacts nursing homes, and we're advocating for greater protection. It's our hope that by shining a light on what's happening, the families will have the information they need to make decisions and policy makers will prioritize the safety of highly vulnerable nursing homes.

Bill Walsh: How can people find out more about what's happening inside nursing homes?

Megan O'Reilly: AARP has a very informative website called the nursing home dashboard, which is devoted to tracking and analyzing COVID data in nursing homes. We've been hosting this online dashboard for a full year now. This information can help families advocate on behalf of their loved ones. Anyone is welcome to visit us online and learn more at aarp.org/nursinghomedashboard.

Bill Walsh: OK. That's aarp.org/nursinghomedashboard. All one word. Thanks so much for being here, Megan, and giving us those updates.

Megan O'Reilly: Great. Thank you.

Bill Walsh: It's now time to address your questions about the coronavirus with Dr. Passaretti and Lori Smetanka. … I'd like to bring in my AARP colleague Mike Watson to help facilitate your calls today. Welcome, Mike.

Mike Watson: Thanks, Bill. Delighted to be here.

Bill Walsh: All right, let's take our first question.

Mike Watson: Our first question is going to be BJ from Louisiana.

Bill Walsh: Hey, BJ. Welcome to the program. Go ahead with your question.

BJ: Thank you very much. And we surely are enjoying all the information that you're giving us. My question is, we saw our famous governor, John Bel Edwards, receive his booster for COVID as well as his flu shot maybe a couple of weeks ago — one on right arm and one on the left arm. My question is, as a nurse, we are holding that if you have never had any type of reaction, negative for your flu shot, you still need to wait. … If you get your flu vaccine and then wait two, three weeks or even a month before getting your COVID booster, because if you take them simultaneously, if you do have a reaction, you would not know which you're having to reaction from — from the COVID booster or from the flu shot. So that was my question, but that's what I have done. That's my rationale for me holding out from my mom and I; she's 95 and I'm 76. So, just want some feedback on that and how relevant you think that is for that particular rationale.

Bill Walsh: I think it's a great question. Dr. Passaretti, can you address that?  

Katie Passaretti: Yeah, it really is a great question, and an important question. Early on when the COVID vaccines were released, there was a recommendation to separate out the COVID vaccine from other types of vaccines by 14 days. What we have seen since then is that there's really no either increased risks from getting two different types of vaccines at the same time, nor is there an impact on effectiveness of either vaccine. So that recommendation to space out the vaccines went away and myself, I did the same thing as your governor. I got my flu shot and my COVID shot as an infectious disease specialist, kind of looking at this data, on the same day, at the same time. And I think it's important to recognize we are heading into flu season and just coming down off a large surge of COVID cases.

So, unfortunately the anticipation is that flu season will be worse this year than it was last year because large chunks of the country aren't masking and some of those distancing measures have kind of gone away. So making sure that we are protecting individuals as much as we can from both infection with COVID and influenza is super important right now and that it really is OK to go ahead and get those vaccines at the same time, whether it's flu in COVID, COVID and tetanus, any of those now, really would encourage people to go ahead and do what makes sense for them personally. But it is fine to get the vaccines at the same time.

Bill Walsh: Great. OK. Thanks for that, Dr. Passaretti. Mike, who's our next caller?

Mike Watson: So our next question is going to be from Lisa online. And Lisa asks, “What happens if someone tests positive in a nursing home? Are they isolated? Are they taken to a hospital? What types of infection controls are there in place?”

Bill Walsh: Lori, I wonder if you can address this. I assume it kind of matters what state you're in, but can you make any general statements and let our listeners know how to find out more?

Lori Smetanka: Sure. So if a person does test positive at a nursing home, they're quarantined. If it's a resident they’ll be quarantined onsite, and if it's a staff person, they would have to leave and quarantine at home. They are isolated for a period of time. There would be continued testing during the time that they're being quarantined until they receive negative tests or complete their quarantine period. Whether or not they're taken to the hospital would depend on their symptoms. And so if they need additional medical attention, they would most likely be transferred, but otherwise they may just be treated onsite at the facility. While someone is quarantined, one of the things to remember is that while generally they can't receive just general visitors, they are still eligible to receive compassionate care visits. So if they need some special assistance or special supports because of concern about decline or the impact of being isolated, they are still eligible for compassionate care visits. Or if they're at the end of life, they could still receive visits from their family members at the end of life.

Bill Walsh: Let me follow up on that. If somebody does test positive within a skilled nursing facility, is it a requirement that the families are notified, even families of other residents?

Lori Smetanka: Well, that's a really good question. They should certainly notify the family of the resident who tests positive. They may or may not notify the families of other residents. Certainly, it makes good sense to let family members know that someone in the facility has tested positive  so that they also potentially could get tested themselves if there's a need for that contact tracing or if they had been in the facility and had spent any time around them.

So it's good practice, I think, to let people know, but certainly whether there's no requirement that the facility let other families know at this time. But certainly the family of the resident, if a resident tests positive, they should certainly be notified.

Bill Walsh: OK. Thank you very much, Lori. Mike, who's our next caller?

Mike Watson: Our next caller is going to be Jane from California.

Bill Walsh: Hey Jane, welcome to the program. Go ahead with your question.

Jane: Oh, hi. I've heard Dr. Fauci and other doctors on media say that we should enjoy the holidays. And I'm wondering, how about seniors over 75 with relatives flying in that will be staying with them for a few weeks. Everybody will be boosted up by then. And they're from places that have worse statistics than what, where I live or where the person lives. So how do we do that? Enjoy the holidays and bring new people into our fold, so to speak, in our home, to be there for a while? I'm not sure how to do that.

Bill Walsh: Let's find out, Jane. That's a very timely question. Dr. Passaretti, can you offer any advice?

Katie Passaretti: Yeah, it is a great question. And so, so important … not only has COVID had a huge impact on everyone, but the isolation and emotional and psychological impact of COVID is seemingly never-ending. And a big chunk of that is being able to reconnect with people, reconnect with loved ones. So it is important to figure out how to be able to see the people that we love as safely as possible.

I do think there's a bit of individual risk assessment that has to go on. So the most important things we can do is make sure everyone that's coming is vaccinated. And if they're eligible for boosters, go ahead and get a booster that decreases your risk. No matter what your vaccination status is, making sure if anyone has any symptoms of being sick — and that could be COVID, could be flu, could be something else.

We shouldn't in any kind of situation, be mixing and matching if there's anyone with any symptoms. And then if you are going out and about in higher risk settings, indoors in particular, it may still make sense to mask if you're kind of mixing groups and whatnot. But I do think, looking at prevalence of cases in your community, number of cases in your community, taking those extra steps to make sure no one is sick, everyone's vaccinated, wearing masks where it makes sense in higher risk settings, does make sense for the vast majority of people.

I will say, for people that have increased risk — so age is one of those, but like if you have a weak immune system on top of being elderly — in those cases I might advise someone, even with those loved ones visiting, trying to wear masks, that extra layer of protection, to make sure that you're really doing everything you can to stay healthy, but still interact [with] your loved ones.

Bill Walsh: Very good. Thank you for that. Mike, let's take another question.

Mike Watson: Our next question is going to be from YouTube. And this is crouching photographer asking the question about vaccine immunity versus COVID virus immunity, especially concerning the boosters. “There's some disagreement as to whether those who have had the virus have the same immunity as those who are vaccinated, and should both get the booster?”

Bill Walsh: Hmm. That's an interesting question, Dr. Passaretti, can you handle that one?

Katie Passaretti: Yeah, sure. So, we are still very much learning about protection after, quote unquote, natural infection. So the problem with natural infection is that not everyone has the same level of illness. Some people have no symptoms. Some people have very mild symptoms. Some people are really, really sick. Some people have kind of a normal immune system, some don't. So with all those variables, it is much less consistent how an individual is protected after natural infection against future infection. If you have fewer symptoms you might be protected for a short period of time, but not for six months. So there's a lot of variables.

So that is part of the reason why the COVID vaccine has been recommended, even if you have had prior infection, to try to get a consistent level of protection and, honestly, studies that have been done looking at vaccines after natural infection show some of the highest levels of antibodies, levels of protection.

So, do I think people that had natural infections should be at the front of the line for getting a booster? No, they probably have a little bit more protection, but the further you get out from infection, the less consistent that level of protection is, and a booster may make sense. And in particular, if you're a high risk individual, that extra level of protection makes sense.

And the good news is we have not seen any evidence of increased side effects or harm from getting the vaccine after natural infections. So no downsides, potential benefit,  consider doing it, especially as you get further and further out from your natural infection.

Bill Walsh: And have we seen side effects with the boosters?

Katie Passaretti: Yeah, great question. So obviously we're relatively early on in the booster journey, but what the studies that have been done so far on booster show is that the side effects are very similar to what we saw with second doses. So, arm pain, 24–48 hours of feeling run down, a little bit achy, but no change in significant side effects, severe side effects or anything like that. So, typically short-lived, you feel crummy for 24 or 48 hours, and then kind of back to normal for most individuals with boosters.

Bill Walsh: Okay. Thanks, Dr. Passaretti, for that. Mike, let's take another question.

Mike Watson: All right. Our next question is going to be Jan from Illinois.

Bill Walsh: Hey Jan, welcome to the program. Go ahead with your question.

Jan: Hi. I'm very concerned about people who are in nursing homes. They have the least amount of protection as far as I'm concerned, because they don't have anyone to come in to check on them like family members, and they don't have any way to really protect themselves. And I'd like to see more unannounced visits from the health department to check on conditions, because anyone that I've talked to that is in a nursing home or assisted living say the same thing: There's not enough help. And I just feel that they are the most vulnerable to not getting the proper care that they really need at this time. And I'd like to see more money go into protecting the people that need the most protection.

Bill Walsh: Right. Lori, let's talk about Jan's point here. One is, she's pointing out what I think a lot of us who have been in nursing homes and assisted living facilities have seen, which is a labor shortage — and that's part of a national labor shortage. But she also asks about inspection, surprise inspections. How much oversight is there of nursing homes these days? One would think there's more than there has ever been, but is that actually the case?

Lori Smetanka: So, unfortunately nursing homes historically have been short-staffed, and that's been an even bigger problem during the pandemic when a number of staff left because of their own health concerns or themselves got sick. There have been many people that have left the field, and so that's been a real issue and we're in close to a crisis situation with respect to staffing. And so, it's really important that we look at efforts to support staff, support efforts to recruit and … retain people, to keep them in this industry. We've been working with members of Congress to provide supports for facilities to help them recruit and retain staff as well.

So that's certainly been a very critical issue right now. And we do need to try to bring as many people into this field as possible and to support those that are there with the living wage and benefits and proper training. Those are all things that are lacking for many staff right now, and leads to much of their frustrations and causes many people to leave. So that definitely is a big issue. You would think that there's more oversight in nursing homes right now during this pandemic. Unfortunately we had not seen that to be true at the height of the pandemic when so many people, not just family members but ombudsmen and surveyors were not going in on a regular basis.

A lot of the oversight functions have resumed in nursing homes, many ombudsmen — long-term care ombudsman who are advocates for residents — are going back in. They respond to complaints. They try to improve conditions and work with staff and residents to not only help people understand rights,     but understand that people need to be properly cared for and to do what they're supposed to do to provide care for residents.

Surveyors are going back in to ensure that they're meeting standards. So definitely we want to make sure that those folks, as well as family members are able to go back in and monitor conditions, and be advocating on behalf of the residents. I think if people have concerns about the conditions in long-term care facilities, they certainly should contact their long-term care ombudsman program for assistance and file a complaint with their state licensing agency that oversees nursing homes to trigger an investigation into what's going on there.     But I think you're absolutely right that we need to have more oversight. We need to pay more attention to conditions of facilities and make sure that residents are being properly cared for.

Bill Walsh: OK, Lori, thanks so much for that. And thanks for all your questions. We're going to take more of your questions shortly. Now let's turn back to our experts. Dr. Passaretti, we've been talking about vaccines and boosters. But there's another piece to the puzzle here. And the drug company Merck has asked the U.S. Food and Drug Administration for emergency use approval of its COVID-19 antiviral pill. This is a treatment for COVID-19,     and the clinical trials have exceeded expectations.

If approved, how quickly will this oral drug become available and how will it, along with Pfizer's antiviral pill, change the approach for treating people with COVID-19?

Katie Passaretti: This is a great question. And it's super exciting. All our treatments for COVID up till now have been intravenous treatments and/or primarily utilized with people that are sick enough to be in the hospital. Merck's drug Molnupiravir that is slated to go in front of the FDA for potential emergency use authorization at the end of November has released information suggesting it is very effective, if given within the first five days of symptom onset, at decreasing risk of hospitalization and more severe disease. So that ability to have an outpatient treatment, that's a pill that's potentially more accessible than the current treatment, could certainly be a game changer.

The only thing I would say is the study suggests that it is most impactful if the infection is caught early. So it will be super important if that is approved to seek treatment early. And that I would advise people not to kind of put all their hopes on a medication for treatment. It's still remained exquisitely important that people get vaccinated.

So it's not just, oh, we have a treatment. This will fix everything. We don't need vaccines anymore. We need vaccines. It's great to have a treatment option for these instances and both are going to be really, really important. The earliest           that potentially will get approved is end of November, beginning of December, and then will have to kind of be distributed.

So hopefully if all continues to look good by end of the year that Merck medication will be available. The Pfizer antiviral medication is a little bit further out, so they're still looking at that. It doesn't have a date to go in front of the FDA. That works by a little bit, a different mechanism, although in kind of exciting news Pfizer's antiviral, they're looking at also for potential prevention, not just treatment, but preventing exposed people from getting ill, but that will most certainly be next year before that kind of gets reviewed and is potentially accessible.

Bill Walsh: Very good. Thanks for that, Dr. Passaretti. And a moment ago, we were just talking about how consumers, how families can keep an eye on nursing homes where they have loved ones. Lori Smetanka mentioned calling your long-term care ombudsman. I wanted to give our listeners a link online to find those resources — and it's through Lori's organization. You can find the ombudsmen in your state at theconsumervoice.org/get_help.

All right. Dr. Passaretti, let me ask you another question. With seasonal allergies and a return to cold and flu season, how do we distinguish between COVID and the common cold?

Katie Passaretti: So that's been tricky. That was tricky last year. And it's going to continue to be tricky this year. Many of the symptoms of COVID are very similar to the symptoms of the common cold or influenza — congestion, runny nose, feeling achy, fevers. The one symptom of COVID that is relatively specific to COVID is loss of taste and smell. So we don’t typically get that symptom. So if you have that, absolutely — concern for COVID, need to talk to your physician. I would kind of encourage people to have a low threshold for talking to your doctor about getting tested for COVID to help figure that out because the symptoms can be so similar.

I've had a number of people say, oh, I just have a cold that ended up having COVID. So, because there's so much overlap, that testing piece is going to continue to be important through this year’s cold and flu season. And,           allergies are the bane of our existence, right? The seasonal allergies, the congestion, runny nose … it's very tricky sometimes to distinguish, but we will continue to have to err on the side of caution and have low threshold for testing so that we can identify those cases, and make sure that spread is aborted as much as possible.

Bill Walsh: Let me ask you about testing, Are home-based COVID tests effective?

Katie Passaretti: Yeah. So all tests for diagnosis of infections or anything have pluses and minuses. So the home-based tests tend to be a type of test called antigen testing. Those are most useful if you have a high clinical suspicion. So most useful, if someone has symptoms suggestive of COVID; a little bit less useful if you're asymptomatic and just want to, quote unquote, know that you're positive.

It is important to know that you can have both false negatives and false positives with those tests. So if the result isn't matching up with how you're feeling, so if you have symptoms, and specifically if you have loss of taste and smell, shortness of breath, and that test is negative, then talk to your doctor about whether another type of test that's more sensitive may be useful.

And equally, if you use that test because of workplace screening or you want to go travel and it comes back positive, there is that risk, especially in someone without symptoms, of a false positive. So again, it might be something you want to get what's called a PCR test, the more sensitive test that's only done in labs, to make sure that it's truly positive.

I think these tests absolutely are convenient. They absolutely have a role, they're most useful if you have symptoms — and just know that no test is perfect. And if it's not matched, if the result isn’t matching up, talk to your doctor about whether some other type of test makes sense.

Bill Walsh: OK, very good. Thank you very much. Lori, let's turn back to you. The government announced in August that it will make vaccines mandatory for nursing home staff across the country, and facilities that don't comply will be at risk of losing Medicare funding. So they have a pretty powerful incentive to ensure their staff gets vaccinated. When do you expect this to go into effect? And what's it going to mean for nursing home residents?

Lori Smetanka: Yeah, we are expecting to see rules from the Centers for Medicare and Medicaid Services anytime now. Some reports are saying by later this month, we should see the rules come out. The original mandate that they issued had applied just to nursing homes, but it was broadened afterward to apply to all health care workers.

And that does seem to be a factor in why the rules may not have been published yet. But we do know that they're coming, and facilities do need to do everything they can in the meantime, to work with staff, to educate them, to try to meet them where they are, in terms of identifying what their concerns or hesitations are for getting vaccinated. And the more they can do that, in advance of this mandate, I think the better chance we stand of ensuring that people will continue to stay in the field and work in this field moving forward. We've already seen a couple of state mandates go into effect already; in New York, for example, their state mandate has gone into effect.

And, we are seeing that the mandates are having an effect in increasing the numbers of staff being vaccinated, and that definitely is what we want to see. But we still have a long way to go, as we had talked about earlier, where the numbers are not even quite at 70 percent yet, but the vaccines have made the biggest difference. It's been the most effective factor in stemming the spread of the virus in nursing homes and protecting those who are most vulnerable. So we definitely want to, and see, we definitely want to see, big increases in the numbers of staff that are getting vaccinated. It's critical. And we need to remind folks that not only is it safe, but the facilities will be safer places to work.

The more people that are vaccinated, they're not just the residents, but also the staff. And we are definitely hoping that people who may have left because of concerns of their own health and safety and the spread of the virus may come back to work in the field again if they feel that the workplace will be a safer place for them.

So, we are hoping to see the rules soon, and we really are encouraging people to get vaccinated as soon as possible.

Bill Walsh: OK. Thanks, Lori, for that. And now it's time to address more of your questions with Dr. Passaretti and Lori Smetanka.  Mike, who do we have on the line?

Mike Watson: Our next caller is Mary from Texas.

Bill Walsh: Hey, Mary. Welcome to our program. Go ahead with your question.

Mary: Thank you for taking me. I would like to know why these nursing homes are not compelled to be sure that every resident there has their shots. My daughter was in rehab and they were going to give her a shot. She was just missed before they gave her the shot. She went to the place that she was going to live. Her caseworker assured her she would have somebody come there and give her a shot. Well, they never showed up and she was there for a long, long time. And then she got sick and went to the hospital from there. She went to a new nursing home and in that nursing home, they had never given her the shot. She never got the shot at all.

And she took COVID and just in a few days she was gone. I lost my daughter on the 30th of August. And she wanted the shot. The last words she ever said to me was, ‘Mother, if I live through this, I will get the shots even if it's a Johnson and Johnson’ — which she didn't like but she was willing to take it. She said, ‘If I had somebody to put me in automobile and take me to a pharmacy, I'd go now.’

But my daughter never had the chance.

Bill Walsh: Oh, Mary. I'm so sorry to hear that. Let me, let me …

Mary: I am, too. And the reason I'm speaking out is because I can't bring my daughter back. But maybe if this is brought to people's attention … maybe they will enforce that these nursing homes will be sure that these little people had their shots.

Bill Walsh: Well, let's ask about that. Lori, are nursing homes required to give shots to residents; can residents refuse them? What's going on there?

Lori Smetanka: Well, first, I'd like to offer my condolences to you, Mary, on your loss. That's such a big loss to have and a terrible thing. And so I'm really sorry about that. Nursing homes should be doing everything they can to ensure that residents have access to the vaccines, to the shots. … Early on, when the vaccines were made available, there were specific partnerships that were developed with pharmacies to ensure that pharmacists were coming onsite or people were coming on site to deliver the shots to residents.

They are required to be having relationships with pharmacies now, and providing access to vaccines for residents that want it. They definitely should be offering it to them. Right now residents still are permitted to refuse vaccines, just as with any other treatment, but for those people that do refuse the vaccine,     they’re certainly subjected to more frequent testing, required use of protective masks, for example, or other protective equipment, or have other restrictions placed on their ability to participate in activities or in dining or in other events that might be going on with other residents because of the risk that it may pose to themselves and to others.

But the bottom line is that every resident should be offered vaccines, should have the right to them whenever they want to get vaccinated. And the facilities have a responsibility to ensure that that happens. And they have been working with CMS and the Centers for Disease Control and state departments of public health to ensure that the nursing homes are having access to vaccines to the greatest extent possible.

What happened to your daughter, I'm, again, very sorry about that, but that should not be happening for people right now.

Bill Walsh: I mean, it sounds like, Lori, it's really a time to be an advocate for your loved ones in nursing homes.

Lori Smetanka: Absolutely. And again, thanks for raising the website where people can contact the long-term care ombudsman, but they are a terrific resource for help. If you're having questions or concerns or need additional assistance, they can provide support to you as can your state licensing agency and your state department of health.

Bill Walsh: OK. And that site, again, is theconsumervoice.org/get_help. There you can find links to the ombudsman program in your state, and these folks … it's their job every day to help advocate for people like us, like all of us consumers, interacting with long-term care facilities. Reach out to them, they're there to help.

Okay. Mike, who's our next caller?

Mike Watson: Our next caller is Craig from Minnesota.

Bill Walsh: Hey Craig. Welcome to the program. Go ahead with your question, Craig.

Craig: Hi, thank you all for doing the town hall — has been a lot of great information. And my condolences to Mary for her daughter; that's really sad and unfortunate. This whole thing has been crazy. But right at the beginning, you pretty much answered my question. I've been vaccinated with the Pfizer booster for almost a month now, I guess.

Do you still recommend — and I wear masks when I go into stores, into a lot of places where there's people and try to avoid people —  now do you recommend staying outside of restaurants and bars? I mean, not going, which we have not been doing, my wife and I. Do you recommend staying out of the inside of those places and just staying on patios, if you can?

We're traveling across the country in a few weeks to California to visit relatives and they're all vaccinated, they will be so, but we were going to be really careful in hotels and everywhere we'd go, but we'll have to get food places.

Bill Walsh: Thank you, Craig. Let's ask Dr. Passaretti about this. I mean, people are thinking about holiday travel, even if they've been vaccinated and received a booster. What advice would you give them about being safe, whether they're in homes, whether they're out at restaurants or other places?

Katie Passaretti: Yeah, really good question. So the things that we have seen that increase risk throughout the course of the pandemic, looking at where you're traveling to and through and seeing where are areas that might be more concerning. So there's a lot of resources on the CDC site, local sites, kind of giving you an idea of cases in communities and states and whatnot. So is it an area with high amounts of transmission, low amounts of transmission? And in those areas with higher transmission, even if you're vaccinated and boosted, when you're in higher risk setting — so indoors, crowded, when you don't know if people are vaccinated, unvaccinated, especially kind of restaurants where you may or may not be masked — it may make sense to err on the side of caution and pick those outdoor settings.

It's going to continue to be like what’s the risk of where you're going to and chipping away at that risk for you personally. So myself, I'm still kind of savoring eating outside where there's open air, good air circulation, and wearing a mask when it's inside. Now, I'm in an area that still has a good amount of pre-admission and relatively mediocre kind of vaccination rate.

So that may be different in an area where everything's under control, 90 percent of the population is vaccinated. Then my comfort level goes up with eating inside and whatnot. So, unfortunately, there's not one flat answer for that. It's going to kind of look at what's the risk of the settings. The lower risk settings are where you're comfortable, the vaccination rates are high, outside is safer than inside. And the density of people, air circulation, the higher kind of density of people in a space, the higher risks. So those are the situations to kind of     take into account and make an informed decision on kind of what protective measures to take.

Bill Walsh: Okay. Thanks for that. Mike, let's take another question.

Mike Watson: All right. Our next question is going to be from Facebook. And Sandy is asking, “If requested are nursing homes required to tell me the vaccination status of my loved one’s caretaker?”

Bill Walsh: Hmm. That's an interesting question. Lori, can you help with that? And maybe talk about also, just more broadly, what the rights of families are in demanding — whether it's visibility or whether it's getting a shot for their loved one, like Mary was talking about.

Lori Smetanka: Sure. So the facilities should tell you the percentage rates of vaccinations among staff and residents, but they won't give you specific information about a particular caretaker or a particular resident. So that's     information that is kept private for those individuals and is not made public or shared with others.

Hopefully, they are already sharing that information with you. And as I mentioned before, the percentages of vaccination rates are something that the nursing homes are required to report to the federal government, and they are posted on the federal government's website right now on care compare, where you can get that specific information — certainly there's no reason to keep that secret. It's something that people want to know, and it helps them make informed decisions about not only whether they want to have a loved one go into that nursing home, but whether they want their loved one to stay in that nursing home or how they may respond to visitation or interactions with that facility during that time.

Bill Walsh: OK. Thanks for that, Lori. Mike, let's take another question.

Mike Watson: All right. Our next question is going to be Philip from Ohio.

Bill Walsh: Hey Philip. Welcome to the program. Go ahead with your question.

Philip: Thank you. My question was … how long does the a booster shot give you a good level of protection, and will we have to continue taking booster shots every six months or eight months or one every year, something like that?

Bill Walsh: Yeah, it's a good question. I'll ask Dr.Passaretti about it. My guess is you're going to say, we're not sure yet.

Katie Passaretti: Absolutely correct. And is a great question. It's a question we've been struggling with, kind of, since the vaccine first became available. But the reality is we just don't know yet. We have experience with plenty of vaccines in the past where a booster at one point in time is sufficient for kind of giving you the protection that is needed, and you may not need another.

But I think the, my suspicion, the suspicion overall is that COVID is a respiratory virus, and we've seen with delta and other variants, the virus changes over time. So, ultimately it may be something like the flu where we get a yearly vaccine because that virus is kind of constantly changing, and we need to bump up our immune response, our protection.

But I think we just need simply need more time to be able to know for sure. And as we've seen for the past two years, we will continue to learn and adapt response based on the data as it evolves.

Bill Walsh: Well, and as it has been with this pandemic from the beginning, people just need to stay tuned and keep an eye on the news and listen to experts to find out what's happening next.

I'd like to thank both of our experts for answering all our questions. This has been a really informative discussion. And thank you, our AARP members, volunteers and listeners for participating is this discussion as well.

AARP, a nonprofit, nonpartisan membership organization, has been working to promote the health and well-being of older Americans for more than 60 years. And in the face of this crisis, we're providing information and resources to help older adults and those caring for them protect themselves from the virus, prevent its spread to others, while taking care of themselves.

All of the resources referenced today, including a recording of the Q&A event, can be found at aarp.org/coronavirus starting tomorrow, Oct. 22. Go there if your question was not addressed, and you'll find the latest updates as well as information created specifically for older adults and family caregivers. We hope you learned something that can help keep you and your loved ones healthy.

Please join us Nov. 4 at 1 p.m. ET for another live event, answering your questions about the coronavirus. We hope you can join us. Thank you, and have a good day. This concludes our call.

[00:00:00] Bill Walsh: Hello. I am AARP Vice President Bill Walsh, and I want to welcome you to this important discussion about the coronavirus. Before we begin, if you'd like to hear this telephone town hall in Spanish, press * zero on your telephone keypad.

[00:00:23] AARP, a nonprofit, nonpartisan membership organization, has been working to promote the health and well-being of older Americans for more than 60 years. And the face of the global coronavirus pandemic, AARP is providing information and resources to help older adults and those caring for them. The past week has brought a wave of good news on the COVID-19 vaccine booster, shots and treatments, but it has also prompted a lot of questions about who is eligible and when. Across the country, the number of new cases of COVID continues to trend steadily downward, which is welcome news.

[00:01:00] However, it's a different story in the nation's nursing homes, where we've seen an uptick in new cases and COVID-related deaths. Today we'll hear from an impressive panel of experts on these issues and more. If you've participated in one of our tele-town halls before, you know this is similar to a radio talk show, and you have the opportunity to ask your questions live.

[00:01:23] For those of you joining us on the phone, if you'd like to ask a question about the pandemic press * 3 on your telephone to be connected with an AARP staff member who will note your name and question and place you in a queue to ask that question live. If you're joining on Facebook or YouTube, you can post your question in the comments section.

[00:01:44] We have some outstanding guests joining us today, including an infectious disease expert and another on family caregiving. We'll also be joined by my AARP colleague Mike Watson, who will help facilitate your calls today. This event is being recorded and you can access the recording at aarp.org/coronavirus.

[00:02:24] Now I'd like to welcome our guests. Katie Passaretti, M.D., is the chief epidemiologist at Atrium Health in the Southeast.

[00:02:53] Welcome to the program, Dr. Passaretti.

[00:02:57] Katie Passaretti: Thank you.

[00:02:58] Bill Walsh: All right. And our other guest is Lori Smetanka. Lori is the executive director of the National Consumer Voice for Quality Long-Term Care. Welcome back to the program, Lori.

[00:03:09] Lori Smetanka: Thanks, Bill. Glad to be here.

[00:03:11] Bill Walsh: Let's go ahead and get started with the discussion. Dr. Passaretti, let's begin with you. I know our listeners have a lot of questions on booster shots. Would you mind reviewing the basics for us and the developments this week? Who is eligible? Can you mix brands? And of course, there's a booster for the Pfizer vaccine. Is there a booster for J& J and Moderna nearing approval?

[00:03:46] Katie Passaretti: Great questions. It's been a couple of weeks of kind of evolving information. Just to level set first, I want to draw the distinction between third doses for people that are moderately or severely immunocompromised, which are intended to get those individuals whose immune system protection is lower to the same level of protection as someone with a quote-unquote normal immune system. And that has been approved for both Pfizer and Moderna. When we're talking about boosters, we're talking about broader use of an additional dose of vaccine, because over time, the protection from the vaccine has decreased somewhat. So what is currently approved is if you were initially fully vaccinated with Pfizer, both doses, at least six months out, and considered high risk.

[00:04:44] So the recommended to get the booster are individuals, all individuals over the age of 65, and then anyone between 50 and 65 that have other medical problems it's recommended. And people that can consider a booster within the current recommendations are those 18 to 50, again, with other medical conditions, which may be diabetes, obesity, the usual kind of things that we've heard throughout the pandemic, or individuals that are at high risk for exposure due to occupation or institutional settings. So like health care workers like myself can go ahead and get a booster. So the current discussion, and I will say the CDC and ACIP, which is the group of scientists that weigh in in the U.S. on immunization recommendations, are meeting as we speak about Moderna, Johnson and Johnson, and whether we can mix and match different types of vaccines.

[00:05:51] The FDA vaccine advisory group met over the past week, and their recommendation that will be considered by the ACIP and CDC for Moderna is essentially exactly what I said for Pfizer. So more than six months out, it's high risk group, reasonable to get a booster to boost up that level of protection. Johnson and Johnson, it appears that the recommendations are going to be different. And that's reflecting that Johnson and Johnson at baseline has a little bit lower effectiveness in preventing illness from COVID. So for that particular vaccine, what the FDA has approved is for anyone, not just high risk, that got Johnson and Johnson, if you're more than two months out from getting Johnson and Johnson, consider getting a booster to boost up that level of protection.

[00:06:51] The other kind of burning question on everyone's mind is can we mix and match different vaccines? So all of the vaccines have primarily been studied in isolation, right? So Pfizer, Pfizer; Moderna with Moderna. We are starting to get a hint of data, both from Europe and from a recently released NIH study, suggesting that, one, there isn't harm associated with mixing and matching vaccines. And two, in some cases specifically if you got the Johnson and Johnson type of vaccine, there may be actually extra protection offered by getting at mRNA — so that’s Pfizer or Moderna. So that data is very early. It'll be interesting to see what the CDC recommends. The FDA has opened the door to more mixing and matching.

[00:07:49] So, that's the piece that will be interesting to see where the CDC comes out at the end of today. I suspect they will also say it's reasonable to consider mixing and matching vaccines, but we have to stay tuned to see what the official recommendations are.

[00:08:06] Bill Walsh: A lot more to come on that front. Thanks very much for that, Dr. Passaretti. And let me follow up quickly. So if you're fully vaccinated with a booster, can you still carry and spread the virus? I asked because I'm wondering in what circumstances it's necessary to mask or social distance if you've been vaccinated and gotten a booster, and we've all seen large crowds at public and entertainment events.

[00:08:31] Is this a cause for concern, given that a core of the country still isn't vaccinated?

[00:08:37] Katie Passaretti: Yeah, so vaccines are amazing. They have saved millions and millions of lives, but they are not perfect. So yes, someone that is fully vaccinated, even with a booster, could potentially carry and spread the virus. Having said that, your risk of getting infected, the length of time that you are able to spread the virus is much lower if you are vaccinated. And Pfizer actually just came out today with data that showed a 95 percent protection against any infection if you get a booster. So that booster bumps up your level of protection, the vaccines are great at baseline at kind of decreasing that risk in general, decreasing the risk of you getting infected and spreading to other people, and that booster helps get that higher. I do think we are, fortunately, as you mentioned, decreasing in cases. The level of community burden is coming down after this very kind of hard, hard surge from delta over the past couple of months, but as we get boosters and higher levels of just baseline vaccination in our communities, and that amount of community cases come down, things like larger events, particularly outdoors, become less risky. So I think we're headed toward a better area. I think for many people boosters can help prevent that spread and are a good thing moving forward.

[00:10:10] Bill Walsh: Very good. Thank you very much. Now Lori, let's turn to you. We just heard Dr. Passaretti talk about a steadily downward trend in new cases, but that's not the same story in the nation’s nursing homes. … We've seen the number of nursing home deaths from COVID almost double in September. What's causing that spike?

[00:10:39] Lori Smetanka: Sure. The numbers between July and September have increased significantly — almost 400 percent in terms of cases, and higher numbers with respect to deaths, too. And we know that the increase is primarily due as a result of the delta variant, but contributing to that is the low vaccination rates among staff and others that are bringing it into facilities, where then it spreads quickly among the staff and the residents.

[00:11:08] This population continues to be very vulnerable to COVID, and the spread in the setting is so alarming because how vulnerable they can be. Fortunately, nearly 90 percent of residents have been vaccinated, but many are susceptible to the breakthrough infections. And so that's obviously been a really big problem.

[00:11:30] Another piece of it is that as the numbers increase, it's important to point out that the COVID increases … it's not just the COVID cases, but it also affects the ability of residents to receive visits from family and friends, their ability to participate in group activities, meals in the dining room and more. And so it really leads to isolation of residents, and the impact of that, that we've seen over the last year and a half, has been significant on residents’ physical and mental health. So we really want to ensure that we get those numbers down again. The biggest factor that's helped protect residents has been the vaccine, so we are strongly encouraging all staff, residents, families, anyone entering a nursing home to be vaccinated and ensure that proper infection prevention protocols are being followed.

[00:12:21] Bill Walsh: Well, let me dig into that a little bit. You were talking about the vaccination rates among nursing home staff. And right now it's at about 65 percent nationwide. Now some states have mandated vaccines for nursing home staff, but others have passed legislation that bans employers from requiring vaccines. For families, this can be really confusing. What questions should families ask if they have a loved one in a nursing home and what information should they expect to get?

[00:12:51] And, and what about assisted living? I mean, we don't have the same visibility into assisted living facilities as we do into nursing homes, do we?

[00:13:00] Lori Smetanka: Right. Absolutely. It's definitely confusing for families with all of the different rules, the different mandates and timelines that's happening out there. So it is important to pay attention to what's happening in your state and know what the rules are, but also to know what's happening in your nursing home or your loved ones’ nursing homes.

[00:13:18] So for any long-term care facility, this includes nursing homes or assisted living facilities, we would encourage residents and families to ask questions about the vaccination rates of residents and staff. While they won't give you personal information about who is and who is not vaccinated, they should tell you with no problem what the percentage is of the residents and staff that are vaccinated.

[00:13:42] And as I mentioned, close to 90 percent of residents, and you've noted that more than 65 percent of staff, have been vaccinated so far.

[00:13:52] They should also be asking facilities what they're doing to encourage and supporting their staff to get vaccinated, ensuring that all new residents coming into the facility are vaccinated or have access to vaccines, and how they're working to protect residents from the spread of COVID. Do they have in place their policies and procedures that have to be followed by everyone that comes into the facility to prevent the spread of COVID? Are they ensuring that they're being followed? Are staff being trained appropriately, and are they providing information to residents and families about that? There's no excuse at this point for the staff and others not to have the information they need or to be trained properly in infection prevention protocols.

[00:14:37] The other thing to remember is that … the federal government is also posting vaccination rates on its care compare website, which is where you can get information about nursing homes. And that website is medicare.gov. And you can click on their care compare site and get information, and you can get the actual vaccination rates for staff and residents in nursing homes on that site. For assisted living it's more dependent on what information the state provides, and so you can certainly ask your nursing home or contact your state's department of health for more information about that.

[00:15:14] But we're seeing mandates come down in some states for workers to be vaccinated. We're seeing many employers as you know, both health care providers as well as other employers, that are requiring workers to be vaccinated. And the federal government has issued a mandate, and we're waiting for more information about that and its implementation to come soon.

[00:15:35] Bill Walsh: Very good. Thank you, Lori. Some terrific advice there.

[00:15:44] We're going to get to those live questions shortly, but before we do, I want to bring in Megan O'Reilly. Megan is the vice president of health and family and government affairs at AARP. Welcome, Megan.

[00:16:02] Megan O'Reilly: Delighted to be here, Bill.

[00:16:04] Bill Walsh: In addition to sharing the most current coronavirus information, we'd like to take a few minutes to update our listeners on important issues facing Congress. Megan, thanks for joining us today. What can you tell us about what AARP is fighting for right now that will help older Americans?

[00:16:23] Megan O'Reilly: Thanks Bill. You know, our fight to lower prescription drug prices continues to be one of our biggest priorities. We are urging Congress to allow Medicare to negotiate drug prices with pharmaceutical companies, despite nationwide ads that the drug companies are running that say it would limit choice for consumers. Medicare negotiation would actually maintain choice and dramatically lower the price of life-saving medications, which would benefit all Americans. We're also fighting to have dental, hearing and vision benefits added to Medicare's coverage.

[00:16:56] Bill Walsh: Well, that would be great. And in addition to Medicare, AARP fights to protect Social Security. There's been some news on Social Security this week, hasn't there?.

[00:17:06] Megan O'Reilly: Yes. Congress recently announced that highest Social Security cost of living increase in 40 years. Those receiving Social Security benefits will receive a 5.9 percent boost to checks next year, an average of about $92 a month. This will greatly help older and disabled Americans keep up with rising prices.

[00:17:26] Bill Walsh: That's fantastic news.

[00:17:30] Megan O'Reilly: It is. Many retirees tell us that what they pay at the grocery store or for utilities or prescription drugs is going up much faster than their Social Security checks can cover. These cost of living increases are crucial to help keep up with these rising costs. That being said, we also need to strengthen and protect Social Security for the long term, so that those who paid into the program over their working lives can count on getting the benefits they have earned.

[00:17:56] Bill Walsh: Now, today we've been learning more about the crisis that's still facing nursing homes in the face of COVID-19. Tragically, there've been more than 2,000 nursing home residents’ deaths just in the past month alone. What's happening there?

[00:18:15] Megan O'Reilly: COVID continues to ravage nursing homes across the country. We seeing far too many infections and deaths in these facilities. AARP is leading the way in analyzing and reporting how COVID impacts nursing homes, and we're advocating for greater protection. It's our hope that by shining a light on what's happening, the families will have the information they need to make decisions and policy makers will prioritize the safety of highly vulnerable nursing homes.

[00:18:44] Bill Walsh: How can people find out more about what's happening inside nursing homes?

[00:18:50] Megan O'Reilly: AARP has a very informative website called the nursing home dashboard, which is devoted to tracking and analyzing COVID data in nursing homes. We've been hosting this online dashboard for a full year now. This information can help families advocate on behalf of their loved ones. Anyone is welcome to visit us online and learn more at aarp.org/nursinghomedashboard.

[00:19:16] Bill Walsh: OK. That's aarp.org/nursinghomedashboard. All one word. Thanks so much for being here, Megan, and giving us those updates.

[00:19:28] Megan O'Reilly: Great. Thank you.

[00:19:29] Bill Walsh: It's now time to address your questions about the coronavirus with Dr. Passaretti and Lori Smetanka. … I'd like to bring in my AARP colleague Mike Watson to help facilitate your calls today. Welcome, Mike.

[00:20:04] Mike Watson: Thanks, Bill. Delighted to be here.

[00:20:05] Bill Walsh: All right, let's take our first question.

[00:20:10] Mike Watson: Our first question is going to be BJ from Louisiana.

[00:20:14] Bill Walsh: Hey, BJ. Welcome to the program. Go ahead with your question.

[00:20:19] BJ: Thank you very much. And we surely are enjoying all the information that you're giving us. My question is, we saw our famous governor, John Bel Edwards, receive his booster for COVID as well as his flu shot maybe a couple of weeks ago — one on right arm and one on the left arm. My question is, as a nurse, we are holding that if you have never had any type of reaction, negative for your flu shot, you still need to wait. … If you get your flu vaccine and then wait two, three weeks or even a month before getting your COVID booster, because if you take them simultaneously, if you do have a reaction, you would not know which you're having to reaction from — from the COVID booster or from the flu shot. So that was my question, but that's what I have done. That's my rationale for me holding out from my mom and I; she's 95 and I'm 76. So, just want some feedback on that and how relevant you think that is for that particular rationale.

[00:21:25] Bill Walsh: I think it's a great question. Dr. Passaretti, can you address that?

[00:21:31] Katie Passaretti: Yeah, it really is a great question, and an important question. Early on when the COVID vaccines were released, there was a recommendation to separate out the COVID vaccine from other types of vaccines by 14 days. What we have seen since then is that there's really no either increased risks from getting two different types of vaccines at the same time, nor is there an impact on effectiveness of either vaccine. So that recommendation to space out the vaccines went away and myself, I did the same thing as your governor. I got my flu shot and my COVID shot as an infectious disease specialist, kind of looking at this data, on the same day, at the same time. And I think it's important to recognize we are heading into flu season and just coming down off a large surge of COVID cases.

[00:22:31] So, unfortunately the anticipation is that flu season will be worse this year than it was last year because large chunks of the country aren't masking and some of those distancing measures have kind of gone away. So making sure that we are protecting individuals as much as we can from both infection with COVID and influenza is super important right now and that it really is OK to go ahead and get those vaccines at the same time, whether it's flu in COVID, COVID and tetanus, any of those now, really would encourage people to go ahead and do what makes sense for them personally. But it is fine to get the vaccines at the same time.

[00:23:15] Bill Walsh: Great. OK. Thanks for that, Dr. Passaretti. Mike, who's our next caller?

[00:23:21] Mike Watson: So our next question is going to be from Lisa online. And Lisa asks, “What happens if someone tests positive in a nursing home? Are they isolated? Are they taken to a hospital? What types of infection controls are there in place?”

[00:23:35] Bill Walsh: Lori, I wonder if you can address this. I assume it kind of matters what state you're in, but can you make any general statements and let our listeners know how to find out more?

[00:23:45] Lori Smetanka: Sure. So if a person does test positive at a nursing home, they're quarantined. If it's a resident they’ll be quarantined onsite, and if it's a staff person, they would have to leave and quarantine at home. They are isolated for a period of time. There would be continued testing during the time that they're being quarantined until they receive negative tests or complete their quarantine period. Whether or not they're taken to the hospital would depend on their symptoms. And so if they need additional medical attention, they would most likely be transferred, but otherwise they may just be treated onsite at the facility. While someone is quarantined, one of the things to remember is that while generally they can't receive just general visitors, they are still eligible to receive compassionate care visits. So if they need some special assistance or special supports because of concern about decline or the impact of being isolated, they are still eligible for compassionate care visits. Or if they're at the end of life, they could still receive visits from their family members at the end of life.

[00:25:00] Bill Walsh: Let me follow up on that. If somebody does test positive within a skilled nursing facility, is it a requirement that the families are notified, even families of other residents?

[00:25:13] Lori Smetanka: Well, that's a really good question. They should certainly notify the family of the resident who tests positive. They may or may not notify the families of other residents. Certainly, it makes good sense to let family members know that someone in the facility has tested positive so that they also potentially could get tested themselves if there's a need for that contact tracing or if they had been in the facility and had spent any time around them.

[00:25:46] So it's good practice, I think, to let people know, but certainly whether there's no requirement that the facility let other families know at this time. But certainly the family of the resident, if a resident tests positive, they should certainly be notified.

[00:26:02] Bill Walsh: OK. Thank you very much, Lori. Mike, who's our next caller?

[00:26:06] Mike Watson: Our next caller is going to be Jane from California.

[00:26:10] Bill Walsh: Hey Jane, welcome to the program. Go ahead with your question.

[00:26:15] Jane: Oh, hi. I've heard Dr. Fauci and other doctors on media say that we should enjoy the holidays. And I'm wondering, how about seniors over 75 with relatives flying in that will be staying with them for a few weeks. Everybody will be boosted up by then. And they're from places that have worse statistics than what, where I live or where the person lives. So how do we do that? Enjoy the holidays and bring new people into our fold, so to speak, in our home, to be there for a while? I'm not sure how to do that.

[00:26:50] Bill Walsh: Let's find out, Jane. That's a very timely question. Dr. Passaretti, can you offer any advice?

[00:26:57] Katie Passaretti: Yeah, it is a great question. And so, so important … not only has COVID had a huge impact on everyone, but the isolation and emotional and psychological impact of COVID is seemingly never-ending. And a big chunk of that is being able to reconnect with people, reconnect with loved ones. So it is important to figure out how to be able to see the people that we love as safely as possible.

[00:27:28] I do think there's a bit of individual risk assessment that has to go on. So the most important things we can do is make sure everyone that's coming is vaccinated. And if they're eligible for boosters, go ahead and get a booster that decreases your risk. No matter what your vaccination status is, making sure if anyone has any symptoms of being sick — and that could be COVID, could be flu, could be something else.

[00:27:54] We shouldn't in any kind of situation, be mixing and matching if there's anyone with any symptoms. And then if you are going out and about in higher risk settings, indoors in particular, it may still make sense to mask if you're kind of mixing groups and whatnot. But I do think, looking at prevalence of cases in your community, number of cases in your community, taking those extra steps to make sure no one is sick, everyone's vaccinated, wearing masks where it makes sense in higher risk settings, does make sense for the vast majority of people.

[00:28:31] I will say, for people that have increased risk — so age is one of those, but like if you have a weak immune system on top of being elderly — in those cases I might advise someone, even with those loved ones visiting, trying to wear masks, that extra layer of protection, to make sure that you're really doing everything you can to stay healthy, but still interact [with] your loved ones.

[00:28:59] Bill Walsh: Very good. Thank you for that. Mike, let's take another question.

[00:29:04] Mike Watson: Our next question is going to be from YouTube. And this is crouching photographer asking the question about vaccine immunity versus COVID virus immunity, especially concerning the boosters. “There's some disagreement as to whether those who have had the virus have the same immunity as those who are vaccinated, and should both get the booster?”

[00:29:25] Bill Walsh: Hmm. That's an interesting question, Dr. Passaretti, can you handle that one?

[00:29:30] Katie Passaretti: Yeah, sure. So, we are still very much learning about protection after, quote unquote, natural infection. So the problem with natural infection is that not everyone has the same level of illness. Some people have no symptoms. Some people have very mild symptoms. Some people are really, really sick. Some people have kind of a normal immune system, some don't. So with all those variables, it is much less consistent how an individual is protected after natural infection against future infection. If you have fewer symptoms you might be protected for a short period of time, but not for six months. So there's a lot of variables.

[00:30:15] So that is part of the reason why the COVID vaccine has been recommended, even if you have had prior infection, to try to get a consistent level of protection and, honestly, studies that have been done looking at vaccines after natural infection show some of the highest levels of antibodies, levels of protection.

[00:30:39] So, do I think people that had natural infections should be at the front of the line for getting a booster? No, they probably have a little bit more protection, but the further you get out from infection, the less consistent that level of protection is, and a booster may make sense. And in particular, if you're a high risk individual, that extra level of protection makes sense.

[00:31:03] And the good news is we have not seen any evidence of increased side effects or harm from getting the vaccine after natural infections. So no downsides, potential benefit, consider doing it, especially as you get further and further out from your natural infection.

[00:31:21] Bill Walsh: And have we seen side effects with the boosters?

[00:31:26] Katie Passaretti: Yeah, great question. So obviously we're relatively early on in the booster journey, but what the studies that have been done so far on booster show is that the side effects are very similar to what we saw with second doses. So, arm pain, 24–48 hours of feeling run down, a little bit achy, but no change in significant side effects, severe side effects or anything like that. So, typically short-lived, you feel crummy for 24 or 48 hours, and then kind of back to normal for most individuals with boosters.

[00:32:01] Bill Walsh: Okay. Thanks, Dr. Passaretti, for that. Mike, let's take another question.

[00:32:05] Mike Watson: All right. Our next question is going to be Jan from Illinois.

[00:32:10] Bill Walsh: Hey Jan, welcome to the program. Go ahead with your question.

[00:32:14] Jan: Hi. I'm very concerned about people who are in nursing homes. They have the least amount of protection as far as I'm concerned, because they don't have anyone to come in to check on them like family members, and they don't have any way to really protect themselves. And I'd like to see more unannounced visits from the health department to check on conditions, because anyone that I've talked to that is in a nursing home or assisted living say the same thing: There's not enough help. And I just feel that they are the most vulnerable to not getting the proper care that they really need at this time. And I'd like to see more money go into protecting the people that need the most protection.

[00:33:10] Bill Walsh: Right. Lori, let's talk about Jan's point here. One is, she's pointing out what I think a lot of us who have been in nursing homes and assisted living facilities have seen, which is a labor shortage — and that's part of a national labor shortage. But she also asks about inspection, surprise inspections. How much oversight is there of nursing homes these days? One would think there's more than there has ever been, but is that actually the case?

[00:33:39] Lori Smetanka: So, unfortunately nursing homes historically have been short-staffed, and that's been an even bigger problem during the pandemic when a number of staff left because of their own health concerns or themselves got sick. There have been many people that have left the field, and so that's been a real issue and we're in close to a crisis situation with respect to staffing. And so, it's really important that we look at efforts to support staff, support efforts to recruit and … retain people, to keep them in this industry. We've been working with members of Congress to provide supports for facilities to help them recruit and retain staff as well.

[00:34:30] So that's certainly been a very critical issue right now. And we do need to try to bring as many people into this field as possible and to support those that are there with the living wage and benefits and proper training. Those are all things that are lacking for many staff right now, and leads to much of their frustrations and causes many people to leave. So that definitely is a big issue. You would think that there's more oversight in nursing homes right now during this pandemic. Unfortunately we had not seen that to be true at the height of the pandemic when so many people, not just family members but ombudsmen and surveyors were not going in on a regular basis.

[00:35:11] A lot of the oversight functions have resumed in nursing homes, many ombudsmen — long-term care ombudsman who are advocates for residents — are going back in. They respond to complaints. They try to improve conditions and work with staff and residents to not only help people understand rights, but understand that people need to be properly cared for and to do what they're supposed to do to provide care for residents.

[00:35:41] Surveyors are going back in to ensure that they're meeting standards. So definitely we want to make sure that those folks, as well as family members are able to go back in and monitor conditions, and be advocating on behalf of the residents. I think if people have concerns about the conditions in long-term care facilities, they certainly should contact their long-term care ombudsman program for assistance and file a complaint with their state licensing agency that oversees nursing homes to trigger an investigation into what's going on there. But I think you're absolutely right that we need to have more oversight. We need to pay more attention to conditions of facilities and make sure that residents are being properly cared for.

[00:36:26] Bill Walsh: OK, Lori, thanks so much for that. And thanks for all your questions. We're going to take more of your questions shortly. Now let's turn back to our experts. Dr. Passaretti, we've been talking about vaccines and boosters. But there's another piece to the puzzle here. And the drug company Merck has asked the U.S. Food and Drug Administration for emergency use approval of its COVID-19 antiviral pill. This is a treatment for COVID-19, and the clinical trials have exceeded expectations.

[00:37:21] If approved, how quickly will this oral drug become available and how will it, along with Pfizer's antiviral pill, change the approach for treating people with COVID-19?

[00:37:35] Katie Passaretti: This is a great question. And it's super exciting. All our treatments for COVID up till now have been intravenous treatments and/or primarily utilized with people that are sick enough to be in the hospital. Merck's drug Molnupiravir that is slated to go in front of the FDA for potential emergency use authorization at the end of November has released information suggesting it is very effective, if given within the first five days of symptom onset, at decreasing risk of hospitalization and more severe disease. So that ability to have an outpatient treatment, that's a pill that's potentially more accessible than the current treatment, could certainly be a game changer.

[00:38:25] The only thing I would say is the study suggests that it is most impactful if the infection is caught early. So it will be super important if that is approved to seek treatment early. And that I would advise people not to kind of put all their hopes on a medication for treatment. It's still remained exquisitely important that people get vaccinated.

[00:38:49] So it's not just, oh, we have a treatment. This will fix everything. We don't need vaccines anymore. We need vaccines. It's great to have a treatment option for these instances and both are going to be really, really important. The earliest that potentially will get approved is end of November, beginning of December, and then will have to kind of be distributed.

[00:39:11] So hopefully if all continues to look good by end of the year that Merck medication will be available. The Pfizer antiviral medication is a little bit further out, so they're still looking at that. It doesn't have a date to go in front of the FDA. That works by a little bit, a different mechanism, although in kind of exciting news Pfizer's antiviral, they're looking at also for potential prevention, not just treatment, but preventing exposed people from getting ill, but that will most certainly be next year before that kind of gets reviewed and is potentially accessible.

[00:39:51] Bill Walsh: Very good. Thanks for that, Dr. Passaretti. And a moment ago, we were just talking about how consumers, how families can keep an eye on nursing homes where they have loved ones. Lori Smetanka mentioned calling your long-term care ombudsman. I wanted to give our listeners a link online to find those resources — and it's through Lori's organization. You can find the ombudsmen in your state at theconsumervoice.org/get_help.

[00:40:34] All right. Dr. Passaretti, let me ask you another question. With seasonal allergies and a return to cold and flu season, how do we distinguish between COVID and the common cold?

[00:40:48] Katie Passaretti: So that's been tricky. That was tricky last year. And it's going to continue to be tricky this year. Many of the symptoms of COVID are very similar to the symptoms of the common cold or influenza — congestion, runny nose, feeling achy, fevers. The one symptom of COVID that is relatively specific to COVID is loss of taste and smell. So we don’t typically get that symptom. So if you have that, absolutely — concern for COVID, need to talk to your physician. I would kind of encourage people to have a low threshold for talking to your doctor about getting tested for COVID to help figure that out because the symptoms can be so similar.

[00:41:33] I've had a number of people say, oh, I just have a cold that ended up having COVID. So, because there's so much overlap, that testing piece is going to continue to be important through this year’s cold and flu season. And, allergies are the bane of our existence, right? The seasonal allergies, the congestion, runny nose … it's very tricky sometimes to distinguish, but we will continue to have to err on the side of caution and have low threshold for testing so that we can identify those cases, and make sure that spread is aborted as much as possible.

[00:42:07] Bill Walsh: Let me ask you about testing, Are home-based COVID tests effective?

[00:42:13] Katie Passaretti: Yeah. So all tests for diagnosis of infections or anything have pluses and minuses. So the home-based tests tend to be a type of test called antigen testing. Those are most useful if you have a high clinical suspicion. So most useful, if someone has symptoms suggestive of COVID; a little bit less useful if you're asymptomatic and just want to, quote unquote, know that you're positive.

[00:42:43] It is important to know that you can have both false negatives and false positives with those tests. So if the result isn't matching up with how you're feeling, so if you have symptoms, and specifically if you have loss of taste and smell, shortness of breath, and that test is negative, then talk to your doctor about whether another type of test that's more sensitive may be useful.

[00:43:10] And equally, if you use that test because of workplace screening or you want to go travel and it comes back positive, there is that risk, especially in someone without symptoms, of a false positive. So again, it might be something you want to get what's called a PCR test, the more sensitive test that's only done in labs, to make sure that it's truly positive.

[00:43:36] I think these tests absolutely are convenient. They absolutely have a role, they're most useful if you have symptoms — and just know that no test is perfect. And if it's not matched, if the result isn’t matching up, talk to your doctor about whether some other type of test makes sense.

[00:43:52] Bill Walsh: OK, very good. Thank you very much. Lori, let's turn back to you. The government announced in August that it will make vaccines mandatory for nursing home staff across the country, and facilities that don't comply will be at risk of losing Medicare funding. So they have a pretty powerful incentive to ensure their staff gets vaccinated. When do you expect this to go into effect? And what's it going to mean for nursing home residents?

[00:44:20] Lori Smetanka: Yeah, we are expecting to see rules from the Centers for Medicare and Medicaid Services anytime now. Some reports are saying by later this month, we should see the rules come out. The original mandate that they issued had applied just to nursing homes, but it was broadened afterward to apply to all health care workers.

[00:44:41] And that does seem to be a factor in why the rules may not have been published yet. But we do know that they're coming, and facilities do need to do everything they can in the meantime, to work with staff, to educate them, to try to meet them where they are, in terms of identifying what their concerns or hesitations are for getting vaccinated. And the more they can do that, in advance of this mandate, I think the better chance we stand of ensuring that people will continue to stay in the field and work in this field moving forward. We've already seen a couple of state mandates go into effect already; in New York, for example, their state mandate has gone into effect.

[00:45:24] And, we are seeing that the mandates are having an effect in increasing the numbers of staff being vaccinated, and that definitely is what we want to see. But we still have a long way to go, as we had talked about earlier, where the numbers are not even quite at 70 percent yet, but the vaccines have made the biggest difference. It's been the most effective factor in stemming the spread of the virus in nursing homes and protecting those who are most vulnerable. So we definitely want to, and see, we definitely want to see, big increases in the numbers of staff that are getting vaccinated. It's critical. And we need to remind folks that not only is it safe, but the facilities will be safer places to work.

[00:46:12] The more people that are vaccinated, they're not just the residents, but also the staff. And we are definitely hoping that people who may have left because of concerns of their own health and safety and the spread of the virus may come back to work in the field again if they feel that the workplace will be a safer place for them.

[00:46:32] So, we are hoping to see the rules soon, and we really are encouraging people to get vaccinated as soon as possible.

[00:46:39] Bill Walsh: OK. Thanks, Lori, for that. And now it's time to address more of your questions with Dr. Passaretti and Lori Smetanka. Mike, who do we have on the line?

[00:47:05] Mike Watson: Our next caller is Mary from Texas.

[00:47:09] Bill Walsh: Hey, Mary. Welcome to our program. Go ahead with your question.

[00:47:13] Mary: Thank you for taking me. I would like to know why these nursing homes are not compelled to be sure that every resident there has their shots. My daughter was in rehab and they were going to give her a shot. She was just missed before they gave her the shot. She went to the place that she was going to live. Her caseworker assured her she would have somebody come there and give her a shot. Well, they never showed up and she was there for a long, long time. And then she got sick and went to the hospital from there. She went to a new nursing home and in that nursing home, they had never given her the shot. She never got the shot at all.

[00:47:59] And she took COVID and just in a few days she was gone. I lost my daughter on the 30th of August. And she wanted the shot. The last words she ever said to me was, ‘Mother, if I live through this, I will get the shots even if it's a Johnson and Johnson’ — which she didn't like but she was willing to take it. She said, ‘If I had somebody to put me in automobile and take me to a pharmacy, I'd go now.’

[00:48:26] But my daughter never had the chance.

[00:48:28] Bill Walsh: Oh, Mary. I'm so sorry to hear that. Let me, let me …

[00:48:32] Mary: I am, too. And the reason I'm speaking out is because I can't bring my daughter back. But maybe if this is brought to people's attention … maybe they will enforce that these nursing homes will be sure that these little people had their shots.

[00:48:47] Bill Walsh: Well, let's ask about that. Lori, are nursing homes required to give shots to residents; can residents refuse them? What's going on there?

[00:48:58] Lori Smetanka: Well, first, I'd like to offer my condolences to you, Mary, on your loss. That's such a big loss to have and a terrible thing. And so I'm really sorry about that. Nursing homes should be doing everything they can to ensure that residents have access to the vaccines, to the shots. … Early on, when the vaccines were made available, there were specific partnerships that were developed with pharmacies to ensure that pharmacists were coming onsite or people were coming on site to deliver the shots to residents.

[00:49:34] They are required to be having relationships with pharmacies now, and providing access to vaccines for residents that want it. They definitely should be offering it to them. Right now residents still are permitted to refuse vaccines, just as with any other treatment, but for those people that do refuse the vaccine, they’re certainly subjected to more frequent testing, required use of protective masks, for example, or other protective equipment, or have other restrictions placed on their ability to participate in activities or in dining or in other events that might be going on with other residents because of the risk that it may pose to themselves and to others.

[00:50:28] But the bottom line is that every resident should be offered vaccines, should have the right to them whenever they want to get vaccinated. And the facilities have a responsibility to ensure that that happens. And they have been working with CMS and the Centers for Disease Control and state departments of public health to ensure that the nursing homes are having access to vaccines to the greatest extent possible.

[00:50:55] What happened to your daughter, I'm, again, very sorry about that, but that should not be happening for people right now.

[00:51:00] Bill Walsh: I mean, it sounds like, Lori, it's really a time to be an advocate for your loved ones in nursing homes.

[00:51:06] Lori Smetanka: Absolutely. And again, thanks for raising the website where people can contact the long-term care ombudsman, but they are a terrific resource for help. If you're having questions or concerns or need additional assistance, they can provide support to you as can your state licensing agency and your state department of health.

[00:51:24] Bill Walsh: OK. And that site, again, is theconsumervoice.org/get_help. There you can find links to the ombudsman program in your state, and these folks … it's their job every day to help advocate for people like us, like all of us consumers, interacting with long-term care facilities. Reach out to them, they're there to help.

[00:51:54] Okay. Mike, who's our next caller?

[00:51:57] Mike Watson: Our next caller is Craig from Minnesota.

[00:52:01] Bill Walsh: Hey Craig. Welcome to the program. Go ahead with your question, Craig.

[00:52:05] Craig: Hi, thank you all for doing the town hall — has been a lot of great information. And my condolences to Mary for her daughter; that's really sad and unfortunate. This whole thing has been crazy. But right at the beginning, you pretty much answered my question. I've been vaccinated with the Pfizer booster for almost a month now, I guess.

[00:52:40] Do you still recommend — and I wear masks when I go into stores, into a lot of places where there's people and try to avoid people — now do you recommend staying outside of restaurants and bars? I mean, not going, which we have not been doing, my wife and I. Do you recommend staying out of the inside of those places and just staying on patios, if you can?

[00:53:16] We're traveling across the country in a few weeks to California to visit relatives and they're all vaccinated, they will be so, but we were going to be really careful in hotels and everywhere we'd go, but we'll have to get food places.

[00:53:36] Bill Walsh: Thank you, Craig. Let's ask Dr. Passaretti about this. I mean, people are thinking about holiday travel, even if they've been vaccinated and received a booster. What advice would you give them about being safe, whether they're in homes, whether they're out at restaurants or other places?

[00:53:54] Katie Passaretti: Yeah, really good question. So the things that we have seen that increase risk throughout the course of the pandemic, looking at where you're traveling to and through and seeing where are areas that might be more concerning. So there's a lot of resources on the CDC site, local sites, kind of giving you an idea of cases in communities and states and whatnot. So is it an area with high amounts of transmission, low amounts of transmission? And in those areas with higher transmission, even if you're vaccinated and boosted, when you're in higher risk setting — so indoors, crowded, when you don't know if people are vaccinated, unvaccinated, especially kind of restaurants where you may or may not be masked — it may make sense to err on the side of caution and pick those outdoor settings.

[00:54:47] It's going to continue to be like what’s the risk of where you're going to and chipping away at that risk for you personally. So myself, I'm still kind of savoring eating outside where there's open air, good air circulation, and wearing a mask when it's inside. Now, I'm in an area that still has a good amount of pre-admission and relatively mediocre kind of vaccination rate.

[00:55:15] So that may be different in an area where everything's under control, 90 percent of the population is vaccinated. Then my comfort level goes up with eating inside and whatnot. So, unfortunately, there's not one flat answer for that. It's going to kind of look at what's the risk of the settings. The lower risk settings are where you're comfortable, the vaccination rates are high, outside is safer than inside. And the density of people, air circulation, the higher kind of density of people in a space, the higher risks. So those are the situations to kind of take into account and make an informed decision on kind of what protective measures to take.

[00:55:58] Bill Walsh: Okay. Thanks for that. Mike, let's take another question.

[00:56:03] Mike Watson: All right. Our next question is going to be from Facebook. And Sandy is asking, “If requested are nursing homes required to tell me the vaccination status of my loved one’s caretaker?”

[00:56:14] Bill Walsh: Hmm. That's an interesting question. Lori, can you help with that? And maybe talk about also, just more broadly, what the rights of families are in demanding — whether it's visibility or whether it's getting a shot for their loved one, like Mary was talking about.

[00:56:31] Lori Smetanka: Sure. So the facilities should tell you the percentage rates of vaccinations among staff and residents, but they won't give you specific information about a particular caretaker or a particular resident. So that's information that is kept private for those individuals and is not made public or shared with others.

[00:56:58] Hopefully, they are already sharing that information with you. And as I mentioned before, the percentages of vaccination rates are something that the nursing homes are required to report to the federal government, and they are posted on the federal government's website right now on care compare, where you can get that specific information — certainly there's no reason to keep that secret. It's something that people want to know, and it helps them make informed decisions about not only whether they want to have a loved one go into that nursing home, but whether they want their loved one to stay in that nursing home or how they may respond to visitation or interactions with that facility during that time.

[00:57:46] Bill Walsh: OK. Thanks for that, Lori. Mike, let's take another question.

[00:57:51] Mike Watson: All right. Our next question is going to be Philip from Ohio.

[00:57:55] Bill Walsh: Hey Philip. Welcome to the program. Go ahead with your question.

[00:58:00] Philip: Thank you. My question was … how long does the a booster shot give you a good level of protection, and will we have to continue taking booster shots every six months or eight months or one every year, something like that?

[00:58:19] Bill Walsh: Yeah, it's a good question. I'll ask Dr.Passaretti about it. My guess is you're going to say, we're not sure yet.

[00:58:27] Katie Passaretti: Absolutely correct. And is a great question. It's a question we've been struggling with, kind of, since the vaccine first became available. But the reality is we just don't know yet. We have experience with plenty of vaccines in the past where a booster at one point in time is sufficient for kind of giving you the protection that is needed, and you may not need another.

[00:58:53] But I think the, my suspicion, the suspicion overall is that COVID is a respiratory virus, and we've seen with delta and other variants, the virus changes over time. So, ultimately it may be something like the flu where we get a yearly vaccine because that virus is kind of constantly changing, and we need to bump up our immune response, our protection.

[00:59:19] But I think we just need simply need more time to be able to know for sure. And as we've seen for the past two years, we will continue to learn and adapt response based on the data as it evolves.

[00:59:34] Bill Walsh: Well, and as it has been with this pandemic from the beginning, people just need to stay tuned and keep an eye on the news and listen to experts to find out what's happening next.

[00:59:46] I'd like to thank both of our experts for answering all our questions. This has been a really informative discussion. And thank you, our AARP members, volunteers and listeners for participating is this discussion as well.

[00:59:59] AARP, a nonprofit, nonpartisan membership organization, has been working to promote the health and well-being of older Americans for more than 60 years. And in the face of this crisis, we're providing information and resources to help older adults and those caring for them protect themselves from the virus, prevent its spread to others, while taking care of themselves.

[01:00:22] All of the resources referenced today, including a recording of the Q&A event, can be found at aarp.org/coronavirus starting tomorrow, Oct. 22. Go there if your question was not addressed, and you'll find the latest updates as well as information created specifically for older adults and family caregivers. We hope you learned something that can help keep you and your loved ones healthy.

[01:00:56] Please join us Nov. 4 at 1 p.m. ET for another live event, answering your questions about the coronavirus. We hope you can join us. Thank you, and have a good day. This concludes our call.

Teleasamblea de AARP

El coronavirus: cómo proteger su salud y cuidar de sus seres queridos

Bill Walsh: Hola, soy el vicepresidente de AARP, Bill Walsh, y quiero darles la bienvenida a esta importante discusión sobre el coronavirus. Antes de comenzar, si desean escuchar esta teleasamblea en español, presionen * 0 en el teclado de su teléfono ahora.

[En español]

Bill Walsh: AARP, una organización de membresía sin fines de lucro y no partidista, ha estado trabajando para promover la salud y el bienestar de los adultos mayores durante más de 60 años. Frente a la pandemia mundial de coronavirus, AARP proporciona información y recursos para ayudar a los adultos mayores y a quienes los cuidan.

La semana pasada ha traído una ola de buenas noticias sobre los tratamientos y las inyecciones de refuerzo de la vacuna COVID-19. Pero también ha generado muchas preguntas sobre quién puede recibirlas y cuándo. En todo el país, el número de casos nuevos de COVID-19 continúa con una tendencia constante a la baja, lo cual es una buena noticia.

Sin embargo, es otra historia en los hogares de ancianos del país, donde hemos visto un aumento en los casos nuevos y las muertes relacionadas con COVID-19. Hoy, escucharemos a un impresionante panel de expertas hablar sobre estos temas y otros. Si ya han participado en alguna de nuestras teleasambleas, saben que esto es similar a un programa de entrevistas de radio y tienen la oportunidad de hacer sus preguntas en vivo.

Para aquellos de ustedes que se unan a nosotros por teléfono, si desean hacer una pregunta sobre la pandemia, presionen * 3 en su teléfono para comunicarse con un miembro del personal de AARP, quien anotará su nombre y su pregunta y los colocará en la cola para hacer esa pregunta en vivo. Si se unen a través de Facebook o YouTube, pueden publicar su pregunta en la sección de comentarios.

Hola, si acaban de unirse, soy Bill Walsh de AARP y quiero darles la bienvenida a esta importante discusión sobre la pandemia mundial de coronavirus. Estaremos hablando con expertas líderes y respondiendo sus preguntas en vivo. Para hacer una pregunta, presionen * 3. Y si se unen a través de Facebook o YouTube, pueden publicar su pregunta en los comentarios.

Tenemos unas invitadas sobresalientes que nos acompañan hoy, incluida una experta en enfermedades infecciosas y otra en cuidados familiares. También nos acompañará mi colega de AARP, Mike Watson, quien ayudará a facilitar sus llamadas hoy. Este evento está siendo grabado y podrán acceder a la grabación en AARP.org/elcoronavirus, 24 horas después de que terminemos.

Nuevamente, para hacer una pregunta, presionen * 3 en cualquier momento en el teclado de su teléfono para conectarse con un miembro del personal de AARP. Si se unen a través de Facebook o YouTube, dejen su pregunta en la sección de comentarios.

Ahora me gustaría dar la bienvenida a nuestras invitadas. Katie Passaretti, M.D., es la jefa de epidemiología de Atrium Health en el sureste. Bienvenida al programa, Dra. Passaretti.

Katie Passaretti: Gracias.

Bill Walsh: Está bien, y nuestra otra invitada es Lori Smetanka. Lori es la directora ejecutiva del National Consumer Voice for Quality Long-Term Care. Bienvenida de nuevo al programa, Lori.

Lori Smetanka: Gracias, Bill. Encantada de estar aquí.

Bill Walsh: Muy bien, comencemos con la discusión. Como recordatorio, para hacer una pregunta, presionen * 3 en el teclado de su teléfono o pueden colocarla en la sección de comentarios en Facebook o YouTube.

Dra. Passaretti, comencemos con usted. Sé que nuestros oyentes tienen muchas preguntas sobre las inyecciones de refuerzo. ¿Le importaría repasar los conceptos básicos y las novedades de esta semana? ¿Quién reúne los requisitos? ¿Se puede mezclar marcas? Y, por supuesto, hay un refuerzo para la vacuna Pfizer. ¿Hay un refuerzo para J&J y Moderna a punto de ser aprobado?

Katie Passaretti: Sí, buenas preguntas. Y han sido un par de semanas en las que la información ha ido evolucionando. Solo para establecer la base, en primer lugar, quiero hacer la distinción entre las terceras dosis para las personas que están moderada o severamente inmunodeprimidas, que están destinadas a lograr que las personas cuya protección del sistema inmunitario es menor lleguen al mismo nivel de protección que alguien con un sistema inmune "normal". Y eso ha sido aprobado tanto para Pfizer como para Moderna.

Cuando hablamos de refuerzos, estamos hablando de un uso más amplio que una dosis adicional de vacuna porque con el tiempo, la protección de la vacuna ha disminuido un poco. Entonces, lo que está aprobado actualmente es si inicialmente uno fue vacunado por completo con Pfizer, con ambas dosis al menos hace seis meses y es considerado de alto riesgo.

Por lo tanto, las personas recomendadas para recibir el refuerzo son todas las personas mayores de 65 años, y cualquier persona entre 50 y 65 que tenga otros problemas médicos. Y las personas que pueden considerar un refuerzo dentro de las recomendaciones actuales son aquellas de 18 a 50, nuevamente, con otras enfermedades, que, ya saben, tal vez diabetes, obesidad, el tipo de cosas habituales que hemos escuchado durante la pandemia, o las personas que tienen un alto riesgo de exposición debido a la ocupación o el entorno institucional, como los trabajadores de la salud, como yo, que podemos ir y recibir una dosis de refuerzo.

Respecto a la discusión actual, diré que los CDC y ACIP, que es el grupo de científicos que toman decisiones en EE.UU. sobre las recomendaciones de inmunización, están reunidos en este momento para hablar sobre Moderna, Johnson & Johnson, y si podemos mezclar y combinar diferentes tipos de vacunas.

Así que el grupo asesor de vacunas de la FDA se reunió durante la semana pasada y sus recomendaciones serán consideradas por ACIP y CDC. Para Moderna, es esencialmente exactamente lo mismo que dije para Pfizer, así que después de seis meses, para esos grupos de alto riesgo, es razonable recibir un refuerzo para aumentar ese nivel de protección.

Para Johnson & Johnson, parece que las recomendaciones van a ser diferentes, y eso refleja que Johnson & Johnson de entrada tiene una efectividad un poco menor en la prevención de enfermedades causadas por la COVID-19. Entonces, para esa vacuna en particular, lo que la FDA ha aprobado es que cualquier persona, no solo de alto riesgo, que tiene la Johnson & Johnson, si hace más de dos meses que recibió la Johnson & Johnson, considere la posibilidad de recibir un refuerzo para aumentar ese nivel de protección.

El otro tipo de pregunta en la mente de todos es: "¿Podemos mezclar y combinar diferentes vacunas?" Bueno, todas las vacunas se han estudiado principalmente de forma aislada, ¿verdad? Entonces, Pfizer con Pfizer, Moderna con Moderna, estamos comenzando a obtener una pisca de datos tanto de Europa como de un estudio de los NIH publicado recientemente que sugiere que, primero, no hay daño asociado con la mezcla de vacunas.

Y segundo, en algunos casos, específicamente, si uno ya recibió la vacuna Johnson & Johnson, en realidad puede ofrecer una protección adicional el obtener una ARNm es decir Pfizer o Moderna. Esa información es muy nueva, será interesante ver qué recomiendan los CDC.

La FDA ha abierto la puerta a las mezclas y combinaciones. Entonces, ya sabe, esa es la pieza que será interesante ver que dicen los CDC al final del día de hoy. Sospecho que también dirán que es razonable considerar una combinación de vacunas. Pero tenemos que estar atentos para ver cuáles son las recomendaciones oficiales.

Bill Walsh: Bien, mucho más por venir en ese frente. Muchas gracias por eso, Dra. Passaretti. Y déjeme hacer un seguimiento rápido. Entonces, si uno está completamente vacunado con un refuerzo, ¿aún puede portar y propagar el virus? Pregunto esto porque se me ocurre en qué circunstancias es necesario usar mascarillas y mantener la distancia social si uno se ha vacunado y se ha puesto un refuerzo. Y todos hemos visto grandes multitudes en eventos de entretenimiento público. ¿Es esto un motivo de preocupación, dado que una cuarta parte del país todavía no está vacunada?

Katie Passaretti: Sí. Las vacunas son increíbles. Han salvado millones y millones de vidas, pero no son perfectas. Entonces, sí, alguien que esté completamente vacunado, incluso con un refuerzo, podría potencialmente portar y propagar el virus. Dicho esto, su riesgo de infectarse, el tiempo que puede transmitir el virus es mucho menor si está vacunado.

Y Pfizer acaba de publicar hoy datos que muestran una protección del 95% contra cualquier infección si recibe un refuerzo. Entonces los refuerzos aumentan el nivel de protección, las vacunas son excelentes en la línea de base para disminuir el riesgo en general, disminuir el riesgo de que uno se infecte y propague el virus a otras personas, y ese refuerzo ayuda a aumentar eso.

Sabe, creo que, afortunadamente, como mencionó, están disminuyendo los casos, el nivel de carga comunitaria está disminuyendo después del fuerte aumento causado por delta en los últimos meses. Pero como, ya sabe, obtenemos refuerzos y niveles más altos de vacunación básica en nuestras comunidades y la cantidad de casos comunitarios disminuye, cosas como eventos más grandes, particularmente al aire libre, se vuelven menos riesgosos. Así que creo que nos dirigimos hacia un área mejor, creo que para muchas personas, los refuerzos pueden ayudar a prevenir esa propagación y son algo bueno para avanzar.

Bill Walsh: Muy bien. Muchísimas gracias. Y como recordatorio para nuestros oyentes, si desean hacer una pregunta, presionen * 3 en el teclado de su teléfono. Ahora, Lori, volvamos a ti. Acabamos de escuchar a la Dra. Passaretti hablar sobre una tendencia constante de baja en los casos nuevos. Pero esa no es la misma historia que se cuenta en los hogares de ancianos de la nación, ¿verdad? Hemos visto que el número de muertes en hogares de ancianos por COVID-19 casi se duplicó en septiembre. ¿Qué está causando ese pico?

Lori Smetanka: Claro. Sí, los números entre julio y septiembre han aumentado significativamente, casi un 400% en términos de casos y números más altos con respecto a las muertes también. Y sabemos que el aumento se debe principalmente a la variante delta, pero contribuyen también las bajas tasas de vacunación entre el personal y otros que están llevando el virus a los centros, donde luego se propaga rápidamente entre el personal y los residentes.

Esta población sigue siendo muy vulnerable a la COVID-19. Y la propagación en el entorno es tan alarmante por lo vulnerables que pueden ser. Afortunadamente, casi el 90% de los residentes han sido vacunados, pero muchos son susceptibles a las infecciones posvacunación. Y eso, obviamente, ha sido un gran problema. Otra cosa es que, si bien aumentan los números, es importante señalar que el aumento de COVID-19 no tiene que ver solo con los casos de COVID-19, sino que también afecta la capacidad de los residentes para recibir visitas de familiares y amigos, su capacidad para participar en actividades grupales, comidas en el comedor, y demás.

Y entonces realmente conduce al aislamiento de los residentes. Y el impacto de eso que hemos visto durante el último año y medio ha sido significativo en la salud física y mental de los residentes. Así que realmente queremos asegurarnos de bajar esos números nuevamente, el factor más importante que ayudó a proteger a los residentes ha sido la vacuna.

Por lo tanto, recomendamos encarecidamente a todo el personal, los residentes, las familias y toda persona que ingrese a un hogar de ancianos, que se vacune y se asegure de que se sigan los protocolos adecuados de prevención de infecciones.

Bill Walsh: Está bien, bueno, déjame profundizar un poco en eso. Estaba hablando de las tasas de vacunación entre el personal de los hogares de ancianos, y en este momento está en alrededor del 65% en todo el país. Ahora, algunos estados han exigido vacunas para el personal de hogares de ancianos, pero otros han aprobado leyes que prohíben a los empleadores exigir vacunas.

Sabe, para las familias, esto puede ser realmente confuso. ¿Qué preguntas deben hacer las familias si tienen un ser querido en un hogar de ancianos? ¿Y qué información deberían esperar obtener? ¿Y qué hay de la vida asistida? Quiero decir, no tenemos la misma visibilidad en los centros de vida asistida que en los hogares de ancianos, ¿verdad?

Lori Smetanka: Claro. Absolutamente. Definitivamente es confuso para las familias con todas las diferentes reglas, los diferentes mandatos y los plazos que hay. Por lo tanto, es importante prestar atención a lo que está sucediendo en el estado de uno, saber cuáles son las reglas, pero también saber qué está sucediendo en su hogar de ancianos o en los hogares de ancianos de sus seres queridos.

Entonces, para cualquier centro de atención a largo plazo, esto incluye hogares de ancianos o centros de vida asistida, recomendamos a los residentes y las familias que hagan preguntas sobre las tasas de vacunación de los residentes y el personal. Si bien no les darán información personal sobre quién está y quién no está vacunado, deben informar, sin ningún problema, cuál es el porcentaje de los residentes y el personal que está vacunado.

Y como mencioné, cerca del 90% de los residentes, y usted ha notado que más del 65% de los miembros de personal han sido vacunados hasta ahora. También deben preguntar en los centros qué están haciendo para alentar y apoyar a su personal a vacunarse, asegurándose de que todos los nuevos residentes que ingresan estén vacunados o tengan acceso a las vacunas, y cómo están trabajando para proteger a los residentes de la propagación de COVID-19.

¿Tienen políticas y procedimientos establecidos que deben cumplir todos los que ingresan a los centros para prevenir la propagación de COVID-19? ¿Se aseguran de que se cumplan? ¿Se capacita adecuadamente al personal? ¿Y están proporcionando información a los residentes y familias sobre eso?

En este momento, no hay excusa para que el personal y otros no tengan la información que necesitan o no estén capacitados adecuadamente en los protocolos de prevención de infecciones. La otra cosa que se debe recordar es que el Gobierno federal también publica las tasas de vacunación en su sitio web Care Compare, que es donde uno puede obtener información sobre los hogares de ancianos. Y ese sitio web es www.medicare.gov.

Pueden hacer clic en su sitio Care Compare y obtener información y las tasas de vacunación reales para el personal y los residentes de los hogares de ancianos en ese sitio. Para los centros de vida asistida, depende más de la información que proporciona el estado. Por lo tanto, ciertamente pueden preguntar en el hogar de ancianos o comunicarse con el Departamento de Salud de su estado para obtener más información al respecto.

Pero estamos viendo mandatos en algunos estados para que los trabajadores se vacunen. Como saben, estamos viendo muchos empleadores, tanto proveedores de atención médica como otros empleadores, que exigen que los trabajadores se vacunen. Y el Gobierno federal ha emitido un mandato y estamos esperando más información sobre eso y su implementación próximamente.

Bill Walsh: Muy bien, muy bien. Gracias, Lori, es un excelente consejo. Y como recordatorio para nuestros oyentes, para hacer una pregunta, por favor presionen * 3 en el teclado de su teléfono, o si están en Facebook o YouTube, la pueden publicar en la sección de comentarios. Vamos a llegar a esas preguntas en vivo en breve. Pero antes de hacerlo, quiero traer a Megan O'Reilly. Megan es la vicepresidenta de salud y familia en asuntos gubernamentales de AARP. Bienvenida, Megan.

Megan O’Reilly: Encantada de estar aquí, Bill.

Bill Walsh: Muy bien, además de compartir la información más actual sobre el coronavirus, nos gustaría tomarnos unos minutos para actualizar a nuestros oyentes sobre temas importantes que enfrenta el Congreso. Megan, gracias por acompañarnos hoy. ¿Y qué puede decirnos acerca de aquello por lo que AARP está luchando en este momento que ayudará a los adultos mayores?

Megan O’Reilly: Gracias, Bill. Bueno, nuestra lucha para reducir los precios de los medicamentos recetados sigue siendo una de nuestras mayores prioridades. Instamos al Congreso a permitir que Medicare negocie los precios de los medicamentos con las compañías farmacéuticas.

A pesar de los anuncios a nivel nacional que las compañías farmacéuticas están publicando para decir que limitaría las opciones para los consumidores, la negociación de Medicare en realidad mantendría las opciones y reduciría drásticamente el precio de los medicamentos que salvan vidas, lo que beneficiaría a todas las personas. También estamos luchando para que se agreguen beneficios dentales, de audición y de la vista a la cobertura de Medicare.

Bill Walsh: Incluso además de Medicare, AARP lucha para proteger el Seguro Social. Ha habido algunas noticias sobre el Seguro Social esta semana, ¿no?

Megan O’Reilly: Sí. El Congreso anunció recientemente el aumento más alto del costo de vida del Seguro Social en 40 años. Aquellos que reciban beneficios del Seguro Social recibirán un aumento del 5.9% en sus cheques el próximo año, un promedio de alrededor de $92 al mes. Esto ayudará enormemente a los adultos mayores y discapacitados a mantenerse al día con los precios en aumento.

Bill Walsh: Es una noticia fantástica.

Megan O’Reilly: Lo es. Muchos jubilados nos dicen que lo que pagan en el supermercado o por servicios públicos o medicamentos recetados aumenta mucho más rápido de lo que pueden cubrir sus cheques del Seguro Social. Estos aumentos en el costo de vida son cruciales para ayudar a mantenerse al día con estos costos crecientes. Dicho esto, también necesitamos fortalecer y proteger el Seguro Social a largo plazo para que aquellos que han contribuido al programa durante su vida laboral puedan contar con recibir los beneficios que se han ganado.

Bill Walsh: Está bien. Hoy en día, hemos estado aprendiendo más sobre la crisis que aún enfrentan los hogares de ancianos frente a la COVID-19. Sabe, trágicamente, han muerto más de 2,000 residentes de hogares de ancianos, solo en el último mes. ¿Qué está ocurriendo?

Megan O’Reilly: La COVID-19 continúa devastando hogares de ancianos en todo el país. Estamos viendo demasiadas infecciones y muertes en estos centros. AARP está liderando el camino, analizando e informando cómo la COVID-19 impacta en los hogares de ancianos y abogamos por una mayor protección. Esperamos que al sacar a la luz lo que está sucediendo, las familias tengan la información que necesitan para tomar decisiones, y los legisladores darán prioridad a la seguridad de los residentes de hogares de ancianos altamente vulnerables.

Bill Walsh: Está bien. Bueno, ¿cómo puede la gente saber más sobre lo que sucede dentro de los hogares de ancianos?

Megan O’Reilly: AARP tiene un sitio web muy informativo llamado panel de control de hogares de ancianos, que se dedica a rastrear y analizar datos de COVID-19 en hogares de ancianos. Hemos realizado estos paneles en línea durante un año completo. Esta información puede ayudar a las familias a defender a sus seres queridos. Cualquiera puede visitarnos y obtener más información en aarp.org/nursinghomedashboard.

Bill Walsh: Bien, eso es aarp.org/nursinghomedashboard. Sin espacios. Muchas gracias por estar aquí, Megan, y darnos esas actualizaciones.

Megan O’Reilly: Genial, gracias.

Bill Walsh: Está bien. Ahora es el momento de abordar sus preguntas sobre el coronavirus con la Dra. Passaretti y Lori Smetanka. Como recordatorio, presionen * 3 en cualquier momento en el teclado de su teléfono para conectarse con un miembro del personal de AARP y compartir su pregunta en vivo. Si desean escuchar en español, presionen * 0 en el teclado de su teléfono ahora.

[En español]

Bill Walsh: Ahora me gustaría traer a mi colega de AARP Mike Watson para ayudar a facilitar sus llamadas hoy. Bienvenido, Mike.

Mike Watson: Gracias, Bill. Encantado de estar aquí.

Bill Walsh: Muy bien. Tomemos nuestra primera pregunta.

Mike Watson: Nuestra primera pregunta será BJ de Luisiana.

Bill Walsh: Hola, BJ, bienvenida al programa. Continúe con su pregunta.

BJ: Muchas gracias. Y realmente estamos disfrutando de toda la información que nos brindan. Mi pregunta es, vimos a nuestro famoso gobernador, John Bel Edwards, recibir su refuerzo contra la COVID-19, así como su vacuna contra la gripe quizás hace un par de semanas, una en el brazo derecho, otra en el brazo izquierdo. Mi pregunta es, como enfermera, sostenemos que si nunca ha tenido ningún tipo de reacción negativa con vacuna contra la gripe, aún debes esperar, si recibes la vacuna contra la gripe, y luego esperar dos, tres semanas o incluso un mes antes de recibir el refuerzo contra la COVID-19 porque si las recibes simultáneamente, si tienes una reacción, no sabrás de cuál estás teniendo la reacción, del refuerzo de COVID-19 o de la vacuna contra la gripe. Entonces esa fue mi pregunta. Pero eso es lo que he hecho. Esa es mi razón para esperar, mi madre y yo, ella tiene 95 años y yo 76. Así que solo quiero algunos comentarios al respecto. ¿Y qué tan relevante creen que es eso para esa justificación en particular?

Bill Walsh: No, creo que es una buena pregunta. Dra. Passaretti, ¿puede abordar eso?

Katie Passaretti: Sí, realmente es una buena pregunta, una pregunta importante. Desde el principio, cuando se lanzaron las vacunas contra la COVID-19, hubo una recomendación de separar esa vacuna de otros tipos de vacunas por 14 días. Lo que hemos visto desde entonces es que realmente no existe un mayor riesgo de recibir dos tipos diferentes de vacunas al mismo tiempo, ni hay un impacto en la eficacia de ninguna de las vacunas.

Entonces esa recomendación de espaciar las vacunas desapareció. Y yo hice lo mismo que su gobernador, recibí mi vacuna contra la gripe y mi vacuna contra la COVID-19, como especialista en enfermedades infecciosas, observando estos datos el mismo día a la misma hora.

Y creo que es importante reconocer que nos dirigimos a la temporada de gripe y, estamos bajando de una gran oleada de casos de COVID-19. Entonces, desafortunadamente, la anticipación es que la temporada de gripe será peor este año que el año pasado porque en grandes partes del país no se están utilizando mascarillas y algunas de las medidas de distanciamiento han desaparecido.

Por lo tanto, asegurarnos de proteger a las personas tanto como podamos de la infección por COVID-19 y la influenza es muy importante en este momento y, ya sabe, realmente está bien obtener esas vacunas al mismo tiempo, ya sea que se trate de la gripe y COVID-19, COVID-19 y tétanos, cualquiera de esas, realmente animaría a la gente a continuar y hacer lo que tenga sentido para ellos personalmente, pero está bien recibir las vacunas al mismo tiempo.

Bill Walsh: Genial. Bien, gracias Dra. Passaretti. Mike, ¿de quién es nuestra próxima llamada?

Mike Watson: Nuestra próxima pregunta será de Lisa en línea. Y Lisa pregunta: "¿Qué sucede si alguien da positivo en una prueba en un hogar de ancianos? ¿Se lo aísla? ¿Lo llevan a un hospital? ¿Qué tipos de controles de infecciones existen?"

Bill Walsh: Lori, me pregunto si puede abordar esto. Supongo que en cierto modo importa en qué estado se encuentra. Pero, ¿puede hacer alguna afirmación general y explicar a nuestros oyentes cómo obtener más información?

Lori Smetanka: Claro. Entonces, si una persona da positivo en una prueba en un hogar de ancianos, es puesta en cuarentena. Entonces, si se trata de un residente, aún debe ser puesto en cuarentena en el sitio, y si es un miembro del personal, tendrían que irse y estar en cuarentena en casa. Serán aislados durante un período, se realizarán pruebas continuas durante el tiempo que están en cuarentena hasta que reciban resultados negativos o completen el período de cuarentena.

Si serán llevados o no al hospital dependerá de sus síntomas. Entonces, si necesitan atención médica adicional, lo más probable es que sean transferidos, pero de lo contrario, es posible que solo sean tratados en el lugar, en el centro. Mientras alguien está en cuarentena, una de las cosas que debe recordar es que, si bien en general, no puede recibir visitantes generales, aún pueden recibir visitas de atención compasiva.

Entonces, si necesitan asistencia especial o apoyo especial debido a una preocupación por deterioro o el impacto de estar aislados, aún pueden recibir visitas de atención compasiva o, si están al final de su vida, aún podrían recibir visitas de sus familiares al final de la vida.

Bill Walsh: Déjame seguir con eso. Ahora bien, si alguien da positivo en una prueba en un centro de enfermería especializada, ¿es un requisito que se notifique a las familias, incluso a las familias de otros residentes?

Lori Smetanka: Bueno, esa es una muy buena pregunta. Sin duda, deben notificar a la familia del residente que dé positivo en la prueba. Pueden o no notificar a las familias de otros residentes. Ciertamente, tiene sentido informar a los miembros de la familia que alguien en la el centro ha dado positivo en la prueba para que ellos mismos también puedan hacerse la prueba si es necesario rastrear el contacto o si han estado en el centro y han pasado algún tiempo cerca de ellos.

Creo que es una buena práctica informar a la gente, pero ciertamente no hay ningún requisito de que el centro se lo informe a otras familias en este momento, pero ciertamente sí a la familia del residente. Si un residente da positivo, ciertamente debe ser notificada.

Bill Walsh: Está bien. Muchas gracias, Lori. Mike, ¿de quién es nuestra próxima llamada?

Mike Watson: Nuestra próxima llamada será de Jane de California.

Bill Walsh: Hola, Jane, bienvenida al programa. Continúe con su pregunta.

Jane: Oh, hola. Escuché al Dr. Fauci y a otros médicos en los medios decir que deberíamos disfrutar de las vacaciones. Y me pregunto qué pasa con las personas mayores de 75 años con parientes que vienen de visita y nos quedamos con ellos durante algunas semanas, para entonces todo el mundo habrá recibido su refuerzo. Y son de lugares que tienen peores estadísticas que donde yo vivo o dónde vive la persona. Entonces, ¿cómo hacemos eso? Disfrutar de las vacaciones y traer gente nueva a nuestro hogar, por así decirlo, para que se queden allí por un tiempo. No estoy segura de cómo hacer eso.

Bill Walsh: Sí, bueno, averigüémoslo, Jane. Esa es una pregunta muy oportuna. Dra. Passaretti, ¿puede darnos algún consejo?

Katie Passaretti: Sí, es una gran pregunta y es muy importante, no solo la COVID-19 ha tenido un gran impacto en todos, el aislamiento y el impacto emocional y psicológico de COVID-19 es aparentemente interminable. Y una gran parte de eso es poder volver a conectar con la gente, volver a conectar con los seres queridos.

Por lo tanto, es importante descubrir cómo poder ver a las personas que amamos de la manera más segura posible. Creo que el riesgo individual debe evaluarse. Entonces, lo más importante que podemos hacer es asegurarnos de que todos los que asistan estén vacunados y, si califican para los refuerzos, lo reciban. Eso disminuye su riesgo.

No importa cuál sea su estado de vacunación, asegurarse de que si alguien tiene algún síntoma de estar enfermo, y eso podría ser COVID-19, podría ser gripe, podría ser otra cosa, ya sabe, no deberíamos en ningún tipo de situación juntarnos si hay alguien con algún síntoma. Y luego, si uno va a salir de casa en entornos de mayor riesgo, en interiores en particular, aún puede tener sentido usar mascarilla si se están mezclando grupos y demás.

Pero sí creo, al observar la prevalencia de casos en su comunidad, la cantidad de casos en su comunidad, tomar esos pasos adicionales para asegurarle, ya sabe, que nadie esté enfermo, que todos estén vacunados, que usen mascarilla donde tenga sentido en lugares de alto riesgo, tiene sentido para la gran mayoría de las personas.

Diré, para las personas que tienen un mayor riesgo, la edad es un factor, pero si tienes un sistema inmunitario débil además de ser mayor, en esos casos, podría aconsejar a alguien, incluso con esos seres queridos de visita, que traten de usar mascarilla, esa capa adicional de protección para asegurarse de que realmente están haciendo todo lo posible para mantenerse a salvo, pero aún interactuando y abrazando a sus seres queridos.

Bill Walsh: Está bien, muy bien. Gracias por eso, doctora. Mike, tomemos otra pregunta.

Mike Watson: Nuestra próxima pregunta será de YouTube. Y aquí Crouching Photographer hizo una pregunta sobre la inmunidad que produce la vacuna versus la inmunidad que produce la COVID-19, especialmente en lo que respecta a los refuerzos. Existe cierto desacuerdo en cuanto a si los que han tenido el virus tienen la misma inmunidad que los que están vacunados y si ambos deben recibir la dosis de refuerzo.

Bill Walsh: Esa es una pregunta interesante. Dra. Passaretti, ¿puede responderla?

Katie Passaretti: Sí, claro. Bueno, ya saben, todavía estamos aprendiendo mucho sobre la protección después de una "infección natural". Entonces, el problema con la infección natural es que no todos tienen el mismo nivel de enfermedad. Algunas personas no tienen síntomas. Algunas personas tienen síntomas muy leves. Algunas personas están realmente enfermas. Algunas personas tienen una especie de sistema inmunitario normal, otras no.

Entonces, con todas esas variables, es mucho menos uniforme cómo un individuo está protegido después de una infección natural contra una infección futura... Si uno tiene menos síntomas, es posible que esté protegido por un corto tiempo, pero no por seis meses. Hay muchas variables.

Entonces, esa es parte de la razón por la que se han recomendado las vacunas contra la COVID-19 incluso si uno ha tenido una infección previa, solo debe tratar de obtener un nivel constante de protección. Y, honestamente, los estudios que se han realizado para analizar las vacunas después de las infecciones naturales muestran algunos de los niveles más altos de anticuerpos, niveles de protección.

Entonces, ¿creo que las personas que tuvieron una infección natural deberían estar al frente de la fila para recibir un refuerzo? No, probablemente tengan un poco más de protección. Pero cuanto más tiempo pasa desde la previa infección, menos uniforme es ese nivel de protección y un refuerzo puede tener sentido. Y en particular, si se trata de una persona de alto riesgo, ese nivel adicional de protección tiene sentido.

Y la buena noticia es que no hemos visto ninguna evidencia de un aumento de los efectos secundarios o daños por recibir la vacuna después de una infección natural. Por lo tanto, no hay ningún posible efecto negativo, considere hacerlo, especialmente a medida que pasa cada vez más tiempo de la infección natural.

Bill Walsh: ¿Y hemos visto efectos secundarios con los refuerzos?

Katie Passaretti: Sí, una buena pregunta. Bueno, obviamente, estamos relativamente comenzando a aplicar refuerzos, pero lo que muestran los estudios que se han realizado hasta ahora sobre los refuerzos es que los efectos secundarios son muy similares a los que vimos con las segundas dosis. Entonces, dolor en el brazo, 24 o 48 horas de sensación de agotamiento, un poco de dolor, pero sin cambios ni efectos secundarios importantes, ni efectos secundarios graves o algo por el estilo. Entonces, por lo general, de corta duración, se siente mal durante 24 o 48 horas, y luego la mayoría de las personas con refuerzos vuelven a la normalidad.

Bill Walsh: Está bien, gracias, doctora. Mike, tomemos otra pregunta.

Mike Watson: Muy bien, nuestra próxima pregunta será de Jan de Illinois.

Bill Walsh: Hola, Jan, bienvenida al programa. Continúe con su pregunta.

Jan: Hola. Estoy muy preocupada por las personas que están en hogares de ancianos, tienen la menor cantidad de protección en lo que a mí respecta porque no tienen a nadie que venga a ver cómo están, como miembros de la familia. Y no tienen ninguna forma de protegerse realmente. Y me gustaría ver más visitas sin previo aviso del Departamento de Salud para verificar las condiciones, porque cualquier persona con la que he hablado que está en un hogar de ancianos o en una residencia asistida dice lo mismo, que no hay suficiente ayuda. Y siento que son los más vulnerables al no recibir la atención adecuada que realmente necesitan en este momento.

Bill Walsh: Sí.

Jan: Y me gustaría ver más dinero destinado a proteger a las personas que necesitan más protección.

Bill Walsh: De acuerdo. Lori, hablemos de lo que menciona Jan. Primero, ella está señalando lo que creo que muchos de nosotros que hemos estado en hogares de ancianos y centros de vida asistida hemos visto, que es una escasez de mano de obra. Y eso es en parte por la escasez de mano de obra nacional. Pero también pregunta por inspecciones sorpresa, ¿cuánta supervisión hay en los hogares de ancianos en estos días? Uno pensaría que hay más de lo que ha habido nunca, pero ¿es ese realmente el caso?

Lori Smetanka: Bueno, desafortunadamente, los hogares de ancianos históricamente han tenido poco personal y ese ha sido un problema aún mayor durante la pandemia, cuando varios miembros del personal se fueron debido a sus propios problemas de salud o ellos mismos se enfermaron. Ha habido mucha gente que se ha ido del campo. Y ese ha sido un problema real. Y estamos cerca de una situación de crisis con respecto a la dotación de personal.

Entonces, es realmente importante que analicemos los esfuerzos para apoyar al personal, respaldar los esfuerzos para reclutar y capacitar a las personas y retenerlas para mantenerlas en esta industria. Hemos estado trabajando con miembros del Congreso para brindar apoyo a los centros para ayudarlos a reclutar y retener personal también.

Así que ciertamente ese ha sido un tema muy crítico en este momento. Y tenemos que tratar de atraer a la mayor cantidad posible de personas a este campo y apoyar a los que están allí con un salario digno, beneficios y una formación adecuada. Esas son todas las cosas que le faltan a muchos miembros del personal en este momento y provocan gran parte de su frustración y hacen que muchas personas se vayan. Así que definitivamente es un gran problema.

Uno pensaría que hay más supervisión en los hogares de ancianos en este momento durante esta pandemia. Desafortunadamente, no habíamos visto que sucedía esto en el apogeo de la pandemia cuando tantas personas, no solo miembros de la familia, sino también defensores del pueblo e inspectores, no acudían con regularidad.

Muchas de las funciones de supervisión se han reanudado en los hogares de ancianos. Están regresando muchos defensores del pueblo, defensores del pueblo de cuidados a largo plazo, que son defensores de los residentes, y responden a las quejas. Intentan mejorar las condiciones y trabajan con el personal y los residentes no solo para ayudar a las personas a comprender los derechos, sino también a comprender que las personas deben ser atendidas adecuadamente y hacer lo que se supone que deben hacer para brindar atención a los residentes.

Los inspectores están regresando para asegurarse de que cumplan con las normas. Definitivamente, queremos asegurarnos de que esas personas, así como los miembros de la familia, puedan regresar y monitorear las condiciones y defender a los residentes. Creo que si las personas tienen inquietudes sobre las condiciones en los centros de atención a largo plazo, ciertamente deben comunicarse con su programa de defensores del pueblo de atención a largo plazo para obtener ayuda y presentar una queja ante la agencia estatal de licencias que supervisa los hogares de ancianos para iniciar una investigación sobre lo que está sucediendo allí.

Pero creo que tiene toda la razón en que necesitamos tener más supervisión, debemos prestar más atención a las condiciones de los centros y asegurarnos de que los residentes estén siendo atendidos adecuadamente.

Bill Walsh: Está bien, Lori, muchas gracias y gracias a ustedes por todas sus preguntas. En breve, responderemos más. Como recordatorio, si desean hacer una pregunta, presionen * 3 en el teclado de su teléfono o déjenla en la sección de comentarios en Facebook o YouTube. Y si desean escuchar este programa en español, presionen * 0 en el teclado de su teléfono ahora.

[En español]

Bill Walsh: Está bien. Ahora volvamos a nuestros expertos. Dra. Passaretti, hemos estado hablando de vacunas y refuerzos. Pero aquí hay otra pieza del rompecabezas, y la compañía farmacéutica Merck le pide a la Administración de Alimentos y Medicamentos de Estados Unidos que apruebe el uso de emergencia de su píldora antiviral contra la COVID-19. Este es un tratamiento contra la COVID-19. Y los ensayos clínicos han superado las expectativas. Entonces, si se aprueba, ¿qué tan rápido estará disponible este medicamento oral? ¿Y cómo, junto con la píldora antiviral de Pfizer, cambiará el método para tratar a las personas que tienen COVID-19?

Katie Passaretti: Sí, esta es una gran pregunta y es muy emocionante, todos nuestros tratamientos contra la COVID-19 hasta ahora han sido intravenosos y/o se han utilizado principalmente con personas que están lo suficientemente enfermas como para estar en el hospital. Entonces, el medicamento de Merck, molnupiravir, que se presentará ante la FDA para obtener una posible autorización de uso de emergencia a fines de noviembre, ha publicado información que sugiere que es muy eficaz si se administra durante los primeros cinco días de la aparición de los síntomas con un riesgo menor de hospitalización y enfermedad grave.

Entonces, la posibilidad de tener un tratamiento ambulatorio, es una píldora que es potencialmente más accesible que el tratamiento actual, sin duda podría cambiar las reglas del juego. Lo único que diría es, primero, que los estudios sugieren que es más impactante si la infección se detecta temprano. Por lo tanto, será muy importante buscar tratamiento temprano. Y que aconsejaría a las personas que no pongan todas sus esperanzas en un medicamento para el tratamiento.

Sigue siendo sumamente importante que las personas se vacunen. Así que no es solo, "Oh, tenemos un tratamiento, esto solucionará todo. Ya no necesitamos vacunas". Necesitamos las vacunas. Es genial tener una opción de tratamiento para estos casos. Y ambos van a ser muy, muy importantes. Lo más temprano que puede aprobarse es a fines de noviembre, principios de diciembre, y luego tendrían que ser distribuidos. Así que, con suerte, si todo sigue bien para fin de año, los medicamentos de Merck estarán disponibles.

El medicamento antiviral de Pfizer está un poco más lejos. Todavía lo están analizando, no tienen una fecha para presentarlo a la FDA. Eso tiene un mecanismo un poco diferente. Aunque es una noticia emocionante, el antiviral de Pfizer también está buscando una posible prevención, no solo un tratamiento, sino también la prevención de que las personas expuestas se enfermen. Pero seguramente será el próximo año que se revise y sea potencialmente aceptable.

Bill Walsh: Muy bien. Gracias, Dra. Passaretti. Y hace un momento, estábamos hablando de cómo los consumidores, cómo las familias pueden vigilar los hogares de ancianos donde tienen seres queridos y Lori Smetanka mencionó llamar al defensor del pueblo de atención a largo plazo. Quería darle a nuestros oyentes un enlace en línea para encontrar esos recursos, y es por medio de la organización de Lori que pueden encontrar al defensor del pueblo en su estado en www.theconsumervoice.org\get_help. Es consumervoice.org\get_help.

Muy bien, Dra. Passaretti, déjeme hacerle otra pregunta. Con alergias estacionales y el regreso a la temporada de resfriados y gripe, ¿cómo distinguimos entre la COVID-19 y el resfriado común?

Katie Passaretti: Sí, eso ha sido complicado. Eso fue complicado el año pasado. Y seguirá siendo complicado este año. Muchos de los síntomas de COVID-19 son muy similares a los síntomas del resfriado común o la influenza, congestión, secreción nasal, sensación de dolor, fiebre. El único síntoma de COVID-19 que es relativamente específico de COVID-19 es la pérdida del gusto y el olfato. Y no solemos tener ese síntoma.

Entonces, si uno tiene ese síntoma, absolutamente, puede que sea COVID-19, debe hablar con su médico. En cierto modo, animaría a las personas a tener un umbral bajo para hablar con su médico sobre hacerse la prueba de COVID-19 para ayudar a resolver eso porque los síntomas pueden ser muy similares. Sabe, varias personas me han dicho: "Oh, acabo de tener un resfriado que terminó siendo COVID-19". Entonces, debido a que hay tanta superposición, las pruebas seguirán siendo importantes durante la temporada de resfriados y gripe de este año.

Y las alergias son la pesadilla de nuestra existencia, verdad, las alergias estacionales, la congestión, la secreción nasal, a veces son muy difíciles de distinguir. Pero seguiremos teniendo que pecar de cautelosos y tener umbrales bajos para las pruebas para que podamos identificar esos casos, asegurarnos de que la propagación se anule tanto como sea posible.

Bill Walsh: ¿Verdad? Bueno, déjeme preguntarle sobre las pruebas. ¿Son eficaces las pruebas de COVID-19 en el hogar?

Katie Passaretti: Sí, todas las pruebas, las pruebas para el diagnóstico de infecciones o cualquier cosa tienen ventajas y desventajas. Por lo tanto, las pruebas en el hogar tienden a ser un tipo de prueba llamada prueba de antígeno, y son más útiles si tiene una alta sospecha clínica. Por lo tanto, es más útil si alguien tiene síntomas que sugieren COVID-19.

Es un poco menos útil si uno es asintomático y solo quiere, ya sabe, "saber" que es positivo. Es importante saber que uno puede tener falsos negativos y falsos positivos con esas pruebas. Entonces, si el resultado no coincide con cómo uno se siente, es decir si tiene síntomas, y específicamente, si tiene pérdida del gusto y el olfato, dificultad para respirar y esa prueba es negativa, entonces debe hablar con su médico sobre si puede ser útil otro tipo de prueba que sea más sensible.

Asimismo, si uno usa esa prueba debido a una evaluación en el lugar de trabajo o quiere viajar y sale positivo, existe ese riesgo, especialmente en alguien sin síntomas, que de un falso positivo. Entonces, quizás mejor hacer lo que se llama prueba de PCR, la prueba más sensible que se realiza en laboratorios para asegurarse de que sea realmente positivo.

Entonces, creo que estas pruebas son absolutamente convenientes, absolutamente cumplen un papel. Son más útiles si uno tiene síntomas, y tengan en cuenta que ninguna prueba es perfecta. Y si el resultado no coincide, hablen con su doctor sobre si tendría sentido hacerse algún otro tipo de prueba.

Bill Walsh: Está bien, muy bien. Muchas gracias, doctora. Lori, volvamos a usted. El Gobierno anunció en agosto que hará que las vacunas sean obligatorias para el personal de los hogares de ancianos en todo el país. Y los centros que no cumplan correrán el riesgo de perder los fondos de Medicare. Así que tienen un incentivo bastante poderoso para asegurarse de que su personal se vacune. ¿Cuándo se espera que esto entre en vigor? ¿Y qué va a significar para los residentes de hogares de ancianos?

Lori Smetanka: Sí, esperamos ver las reglas de los Centros de Servicios de Medicare y Medicaid en cualquier momento. Algunos informes dicen que deberíamos verlas a finales de este mes. El mandato original que emitieron se había aplicado solo a los hogares de ancianos, pero luego se amplió para que se aplique a todos los trabajadores de la salud. Y eso parece ser un factor de por qué es posible que las reglas aún no se hayan publicado.

Pero sabemos que van a venir y los centros deben hacer todo lo posible mientras tanto para trabajar con el personal para educarlos, para tratar de encontrarlos donde están en términos de identificar cuáles son sus preocupaciones o dudas para vacunarse. y cuanto más puedan hacer eso, antes de este mandato, creo que tendremos más posibilidades de garantizar que las personas continúen permaneciendo en el campo y trabajando en este campo en el futuro.

Ya hemos visto entrar en vigor un par de mandatos estatales en Nueva York, por ejemplo, su mandato estatal ha cobrado vigencia. Y estamos viendo que los mandatos están teniendo efecto en aumentar el número de personal que se vacuna. Y eso definitivamente es lo que queremos ver. Pero todavía tenemos un largo camino por recorrer, como habíamos hablado antes, y donde las cifras aún no llegan al 70%. Pero las vacunas han producido la mayor diferencia.

Han sido el factor más eficaz para detener la propagación del virus en los hogares de ancianos y proteger a los más vulnerables. Así que definitivamente queremos ver ... Definitivamente queremos ver grandes aumentos en la cantidad de personal que se vacuna, es fundamental. Y debemos recordarle a la gente que no solo es segura, sino que los centros serán lugares más seguros para trabajar mientras más personas se vacunen, no solo son para los residentes sino también para el personal.

Y definitivamente esperamos que las personas que se hayan ido debido a preocupaciones sobre su propia salud y seguridad y la propagación del virus puedan volver a trabajar en el campo nuevamente si sienten que el lugar de trabajo será un lugar más seguro para ellos. Así que esperamos ver las reglas pronto. Y realmente estamos alentando a las personas a que se vacunen lo antes posible.

Bill Walsh: Está bien. Gracias, Lori, por eso. Y ahora es el momento de abordar más preguntas con la Dra. Passaretti y Lori Smetanka. Por favor presionen * 3 en cualquier momento en el teclado de su teléfono para conectarse con un miembro del personal de AARP y hacer su pregunta en vivo o colóquela en la sección de comentarios en Facebook o YouTube. Mike, ¿a quién tenemos en la línea?

Mike Watson: Bill, nuestra próxima llamada es Mary de Texas.

Bill Walsh: Hola, Mary, bienvenida a nuestro programa. Continúe con su pregunta.

Mary: Gracias por atenderme. Me gustaría saber por qué estos hogares de ancianos no están obligados a asegurarse de que todos los residentes tengan sus vacunas. Mi hija estaba en rehabilitación y le iban a poner una inyección. La despidieron antes de que le dieran la inyección. Fue al lugar donde iba a vivir. Su asistente social le aseguró que haría que alguien viniera y le diera una vacuna. Bueno, nunca aparecieron. Y ella estuvo allí durante mucho, mucho tiempo. Y luego se enfermó y fue al hospital. A partir de ahí, se fue a un nuevo hogar de ancianos. Y en ese hogar de ancianos, nunca le habían puesto la inyección. Ella nunca recibió la vacuna en absoluto. Y se contagió de COVID-19 y solo en unos días, murió. Perdí a mi hija el 30 de agosto.

Bill Walsh: Oh, lo siento mucho, Mary.

Mary: Quería la inyección. Las últimas palabras que me dijo fueron: "Madre, si sobrevivo a esto, recibiré la vacuna, incluso si es la Johnson & Johnson", la cual no le gustaba, pero estaba dispuesta a aceptarla. Ella dijo: "Si tuviera a alguien que me pusiera en un automóvil y me llevara a una farmacia, iría ahora". Pero mi hija nunca tuvo la oportunidad.

Bill Walsh: Oh, Mary, lamento mucho oír eso. Déjame traer...

Mary: Yo también. Y la razón por la que hablo es porque no puedo traer de vuelta a mi hija. Pero tal vez si esto llama la atención de la gente, tal vez impongan que estos hogares de ancianos se aseguren de que estas pequeñas personas recibieron sus vacunas.

Bill Walsh: Bueno, preguntemos sobre eso. Lori, ¿se requiere que los hogares de ancianos administren vacunas a los pacientes? ¿Los residentes pueden rechazarlas? ¿Qué está pasando?

Lori Smetanka: Bueno, primero, me gustaría ofrecerle mi pésame, Mary, por su pérdida. Es una pérdida tan grande y algo terrible. Y lo siento mucho por eso. El hogar de ancianos debe hacer todo lo posible para garantizar que los residentes tengan acceso a las vacunas, a las inyecciones. Al principio, cuando las vacunas comenzaron a estar disponibles, se crearon asociaciones específicas con las farmacias para garantizar que los farmacéuticos vayan al lugar o que las personas vinieran al lugar para aplicar las vacunas a los residentes.

Se les exige que mantengan una relación con las farmacias ahora y que proporcione acceso a las vacunas a los residentes que lo deseen. Definitivamente deberían ofrecérsela. En este momento, los residentes todavía pueden rechazar las vacunas al igual que con cualquier otro tratamiento, pero aquellas personas que rechazan la vacuna ciertamente pueden ser sometidas a pruebas más frecuentes, el uso requerido de mascarillas protectoras, por ejemplo, u otro equipo de protección, o tener otras restricciones que les impidan participar en actividades o cenas o en otros eventos que puedan estar sucediendo con otros residentes debido al riesgo que puede representar para ellos mismos y para los demás.

Pero la conclusión es que a todos los residentes se les debe ofrecer vacunas, deben tener derecho a ellas siempre que quieran vacunarse, y los centros tienen la responsabilidad de garantizar que eso suceda. Y han estado trabajando con CMS y los Centros para el Control de Enfermedades y los Departamentos Estatales de Salud Pública para garantizar que los hogares de ancianos tengan acceso a las vacunas en la mayor medida posible. Entonces, lo que le pasó a su hija, lo siento mucho. Pero eso no debería estarle sucediendo a la gente en este momento.

Bill Walsh: Quiero decir, esto parece, Lori, realmente es un momento para ser un defensor de sus seres queridos en los hogares de ancianos.

Lori Smetanka: Por supuesto.

Bill Walsh: Sí.

Lori Smetanka: Una vez más, gracias por mencionar el sitio web donde las personas pueden comunicarse con los defensores del pueblo de atención a largo plazo, pero son un excelente recurso de ayuda si uno tiene preguntas o inquietudes o necesita asistencia adicional, pueden brindar apoyo, al igual que la agencia estatal de licencias y el Departamento de Salud de su estado.

Bill Walsh: Bien, y ese sitio, nuevamente, es consumervoice.org\get_help. Allí pueden encontrar enlaces al programa del defensor del pueblo en su estado y a estas personas. Es su trabajo todos los días ayudar a defender a personas como nosotros, como todos los consumidores que interactuamos con los centros de atención a largo plazo, así que comuníquense con ellos, están allí para ayudar. De acuerdo, Mike, ¿de quién es nuestra próxima llamada?

Mike Watson: Nuestro próximo interlocutor es Craig de Minnesota.

Bill Walsh: Hola, Craig, bienvenido al programa. Continúe con su pregunta, Craig.

Craig: Oh, sí. Hola. Y gracias a todos por hacer la teleasamblea. Ha habido mucha información excelente y mi más sentido pésame para Mary, por su hija. Es realmente triste y lamentable. Lo sé, todo esto ha sido una locura. Pero desde el principio, casi respondieron a mi pregunta. Me han vacunado con el refuerzo de Pfizer hace casi un mes, supongo. Y todavía recomiendan... Y uso mascarilla cuando voy a las tiendas, a muchos lugares donde hay gente y trato de evitar a la gente.

Ahora, ¿recomiendan permanecer afuera en los restaurantes y bares? Quiero decir, lo que no hemos estado haciendo mi esposa y yo. ¿Recomiendan permanecer fuera del interior de esos lugares? Y quedarse en los patios si es posible? Estamos viajando... Viajaremos por todo el país en unas pocas semanas, a California para visitar a familiares y todos están vacunados, lo estarán. Pero vamos a tener mucho cuidado en los hoteles y en todos los lugares a los que vayamos. Pero...

Bill Walsh: Sí.

Craig: Tendremos que conseguir lugares para comer.

Bill Walsh: Gracias, Craig. Preguntémosle a la Dra. Passaretti sobre esto. Quiero decir, la gente está pensando en viajes de vacaciones. Incluso si han sido vacunados y han recibido una dosis de refuerzo, ¿qué consejo les daría sobre cómo estar seguros, ya sea en su hogar, en restaurantes u otros lugares?

Katie Passaretti: Sí, muy buena pregunta. Bueno, las cosas que hemos visto que aumentaron el riesgo a lo largo del curso de la pandemia, hay que tener en cuenta hacia dónde viajas y por dónde estarás viajando y ver dónde hay áreas que podrían ser más preocupantes. Hay muchos recursos en el sitio de los CDC, sitios locales, que le dan una idea de casos en comunidades y estados y todo eso.

Entonces, ¿es un área con altas cantidades de transmisión, o bajas cantidades de transmisión? Y en aquellas áreas con mayor transmisión, incluso si uno está vacunado y reforzado cuando se encuentra en un entorno de mayor riesgo, es decir, en interiores, abarrotados, cuando no sabe si las personas están vacunadas, o no vacunadas, especialmente los tipos de restaurantes donde puede o puede que no estén usando mascarilla puede tener sentido pecar de cauteloso y elegir esos entornos al aire libre.

Así que va a seguir siendo como, cuál es el riesgo del lugar donde va y calcular ese riesgo para usted personalmente. Yo todavía estoy saboreando, comiendo afuera donde hay aire libre, buena circulación de aire y usando mascarilla cuando estoy adentro. Ahora, estoy en un área que todavía tiene una buena cantidad de transmisión una tasa de vacunación relativamente mediocre. Entonces eso puede ser diferente en un área donde todo está bajo control, el 90% de la población está vacunada, entonces mi nivel de comodidad aumenta con comer adentro y todo eso.

Entonces, desafortunadamente, no hay una respuesta única para eso, se trata de ver y evaluar el riesgo en cada lugar, aminorar riesgos donde uno se siente cómodo, las tasas de vacunación son altas, afuera es más seguro que adentro. Y, ya sabe, la densidad de personas, la circulación del aire, en densidades más altas de personas en un espacio, el riesgo es más alto. Así que esas son las situaciones a tener en cuenta y tomar una decisión informada sobre el tipo de medidas de protección que uno debe tomar.

Bill Walsh: Bien, gracias por eso. Mike, tomemos otra pregunta.

Mike Watson: Muy bien, nuestra próxima pregunta será de Facebook, y Sandy pregunta: "Si se solicita, ¿se requiere que los hogares de ancianos me digan el estado de vacunación del cuidador de mis seres queridos?"

Bill Walsh: Esa es una pregunta interesante. Lori, ¿puede ayudar con eso? Y tal vez hablar también de manera más amplia, ¿cuáles son los derechos de las familias que exigen, ya sea visibilidad o si se trata de recibir una vacuna para su ser querido, como Mary mencionaba?

Lori Smetanka: Claro. Los centros deben reportar las tasas de porcentaje de vacunación entre el personal y los residentes, pero no brindarán información específica sobre un cuidador en particular o un residente en particular. Así que es información que se mantiene privada para esas personas y no se hace pública ni se comparte con otros. Así que, con suerte, ya están compartiendo esa información con usted.

Y como mencioné antes, los porcentajes de las tasas de vacunación son algo que los hogares de ancianos deben reportar al Gobierno federal. Y se publican en el sitio web del Gobierno federal ahora mismo en Care Compare, donde uno puede obtener esa información específica. Y ciertamente, no hay razón para mantener ese secreto. Es algo que la gente quiere saber. Y les ayuda a tomar decisiones informadas, no solo sobre si quieren que un ser querido vaya a ese hogar de ancianos, sino también si quieren que se quede en ese hogar de ancianos o cómo pueden responder a las visitas o interacciones con ese centro durante ese tiempo.

Bill Walsh: Bien, gracias por eso, Lori. Mike, tomemos otra pregunta.

Mike Watson: Muy bien, nuestra próxima pregunta será de Philip de Ohio.

Bill Walsh: Hola, Philip, bienvenido al programa. Continúe con su pregunta.

Philip: Gracias. Mi pregunta era ¿durante cuánto tiempo la vacuna de refuerzo brinda un buen nivel de protección? ¿Y tendremos que seguir recibiendo refuerzos cada seis meses u ocho meses o una vez al año, algo así?

Bill Walsh: Sí. Buena pregunta. Le preguntaré a la Dra. Passaretti al respecto. Supongo que dirás: "Aún no estamos seguros".

Katie Passaretti: Tienes toda la razón. Y es una gran pregunta. Es una pregunta con la que hemos estado luchando desde que la vacuna estuvo disponible por primera vez. Pero la realidad es que todavía no lo sabemos. Tenemos experiencia con muchas vacunas en el pasado en las que un refuerzo, en un momento dado, es suficiente para brindar la protección que uno necesita. Y uno puede que no necesite otro.

Pero mi sospecha, la sospecha general es que la COVID-19 es un virus respiratorio, y hemos visto que con delta y otras variantes el virus cambia con el tiempo. Entonces, en última instancia, puede ser algo como la gripe en la que recibimos una vacuna anual porque ese virus cambia constantemente y necesitamos aumentar nuestra respuesta inmunitaria, nuestra protección. Pero creo que simplemente necesitamos más tiempo para poder saber con certeza, y... Ya sabe, durante los últimos dos años, continuaremos aprendiendo y adaptando la respuesta basada en los datos que han evolucionado.

Bill Walsh: Y como ha sido con esta pandemia desde el principio, la gente solo necesita estar atenta, estar atenta a las noticias y escuchar a los expertos para saber qué sucederá a continuación. Me gustaría agradecer a nuestras dos expertas por responder a todas nuestras preguntas. Esta ha sido una discusión realmente informativa. Y gracias a nuestros socios, voluntarios y oyentes de AARP por participar también en esta discusión.

AARP, una organización de membresía, no partidista y sin fines de lucro, ha estado trabajando para promover la salud y el bienestar de los adultos mayores durante más de 60 años. Frente a esta crisis, estamos brindando información y recursos para ayudar a los adultos mayores y a quienes los cuidan a protegerse del virus y a prevenir su propagación a otros mientras se cuidan ellos mismos.

Todos los recursos a los que se hizo referencia hoy, incluida una grabación del evento de preguntas y respuestas, se podrán encontrar en aarp.org/elcoronavirus a partir de mañana, 22 de octubre. Nuevamente, esa dirección web es aarp.org\coronavirus.org. Vayan allí si su pregunta no fue respondida y encontrarán las últimas actualizaciones, así como información creada específicamente para adultos mayores y cuidadores familiares.

Esperamos que hayan aprendido algo que pueda ayudarlos a ustedes y a sus seres queridos a mantenerse saludables. Acompáñennos el 4 de noviembre a la 1 p.m., hora del este, para participar en otro evento en vivo que responda a sus preguntas sobre el coronavirus. Esperamos que puedan unirse. Gracias, que tengan un buen día. Con esto concluye nuestra llamada.