AARP Coronavirus Tele-Town Halls

Bill Walsh: Hello, I'm 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 *0 on your telephone keypad now.

(Española)

Bill Walsh: AARP, a nonprofit, nonpartisan membership organization, has been working to promote the health and well-being of older Americans for more than 60 years. In the face of the global coronavirus pandemic, AARP is providing information and resources to help older adults and those caring for them. You know, it seemed just a month ago that things were beginning to return to normal. But the emergence of the omicron variant has rekindled concerns for many Americans as they prepare to gather for the holidays. While increasing COVID vaccination rates give us some comfort, we know that vaccine protection erodes over time and some 100 million Americans who are eligible for booster shots still haven't gotten them. Meanwhile, on the political front, Congress could be on the cusp of passing historical legislation that could finally lower the drug costs for Americans.

Today we'll hear from an impressive panel of experts about these issues and more, and next week, we'll host a special event with Dr. Francis Collins, head of the National Institutes of Health. 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 coronavirus pandemic, press *3 on your telephone, and you'll 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 two infectious disease experts and a mental health expert. We'll also be joined by my AARP colleague, Jesse Salinas, who will help facilitate your calls today. This event is being recorded and you can access the recording at aarp.org/coronavirus 24 hours after we wrap up.

Now I'd like to welcome our guests. David M. Aronoff, M.D., is director in the Division of Infectious Diseases and the Department of Medicine at Vanderbilt University Medical Center. Welcome back to the program, Dr. Aronoff.

David M. Aronoff: Great to be here. Thank you for having me.

Bill Walsh: All right. We're delighted to have you back. Altha J. Stewart, M.D., is a senior associate dean for Community Health Engagement and associate professor and director in the Division of Social and Community Psychiatry at the University of Tennessee Health Science Center. Welcome back to the program, Dr. Stewart.

Altha J. Stewart: Thank you, Bill, a pleasure to be with you again.

Bill Walsh: All right. And Paula Eckardt, M.D., is the chief in the Memorial Division of Infectious Disease at Memorial Healthcare System. Welcome to the program, Dr. Eckardt.

Paula Eckardt: Thank you for inviting me.

Bill Walsh: All right. Thanks all of you for being here. Let's go ahead and get started. Dr. Aronoff, there were some restrictions at the outset about who is eligible for COVID boosters, but now eligibility has been expanded. Can you talk about who is eligible and why has the booster dose become such a priority? And maybe you could also address how effective the vaccines are against omicron.

David M. Aronoff: Sure, well again, Bill, thank you for having me, and it's an honor to be on with these guests. You know, you're exactly right, we were somewhat staging how we were using boosters, but now they are recommended for anybody over the age of 18 who has already completed the first round of vaccination. If people got the mRNA vaccines, which are offered by Pfizer or Moderna, then they should wait at least six months and then they are eligible for a booster. And if they received the J&J single dose vaccine then after two months have gone by from that vaccination, they are eligible for boosters. You know, we have certainly seen that the vaccines can wane over time in terms of being vulnerable to getting COVID-19. And we're seeing the rise of this variant that goes by the name omicron, that seems to be quite contagious, and we want to make sure that we have the best defenses up against this variant to keep us out of the hospital and to make sure that as few people as possible get sick. And so, we're really urging that now is the time, if you're eligible, to get that booster done.

Bill Walsh: And do we have any information on the effectiveness of the vaccines against omicron? I know it's still early days in that regard.

David M. Aronoff: Yeah, so there's been data from two different sources. One is in the laboratory, in a Petri dish basically, where we can take people's blood after they've been vaccinated and see if the antibodies in their blood can block the virus, in this case the omicron variant, from infecting human cells in a petri dish. And there are data that suggests that after the initial vaccination that our antibodies don't do as well blocking the omicron virus in a petri dish compared to blocking the delta variant or the original variant. However, we very recently learned from data from Pfizer that after a booster dose, those antibody levels in our blood are high enough that, at least in a petri dish in a laboratory, they do effectively block the omicron virus from causing infection. What we don't really know is the effect of these vaccinations out in the real world against the omicron variant. There are some suggestions that people who are vaccinated are protected against getting severe disease, but it's very, very early days still. And I think there's a lot more that we need to learn, but we even learned very recently that the FDA has approved giving a Pfizer booster to 16- and 17-year-olds. And I think the urgency here is that we really want to make sure that as omicron spreads, that we get as much benefit out of available vaccines as we possibly can.

Bill Walsh: Let me follow up on that, Dr. Aronoff. I mean, given the effectiveness of the vaccines in protecting against COVID or at least minimizing its severity, why do you think we haven't seen faster uptake of the booster shots? I mean, what's the message that the hundred million or so people who are eligible for a booster need to hear?

David M. Aronoff: Well, certainly people are going to get boosters, which is fantastic, and I certainly would urge anybody tuned in today to, if you're eligible, to go get boosters. They're free, they're readily available. You know, there's a lot of factors in understanding why people haven't yet gone out to get their booster. Some of it is not knowing where to get the boosters. Questions about whether people are eligible or available for getting boosters. And then, of course, there's fatigue around the issue of, gosh, I've already had two shots, or I've already got vaccinated, they seem to be protecting, do I really need to get this other shot? People are getting flu shots and they may think, you know, I'm just going to wait and see. But as mentioned, these vaccines are not only effective at preventing complications of COVID, but they're also very, very safe, and that can be a concern. Somebody says, "I've had my initial vaccines. What if, when I get my booster, I get a bad reaction?" And what the data are clearly showing us is that the booster shots don't cause worse reactions than the initial vaccines, but we need to be really good at getting that message out.

Bill Walsh: Okay, thank you, Dr. Aronoff. Dr. Eckhardt, let's turn to you and talk about these variants. I feel like we're all learning the Greek alphabet for the very worst reasons. But, of course, as we know the COVID-19 virus continues to mutate, which is why we've seen variants like delta and omicron, and perhaps others. Will that mutation continue indefinitely? And are more boosters likely? I'm wondering if they're going to become ultimately as routine as a flu shot.

Paula Eckardt: Well, that's one of the possibilities is that it will continue to mutate and cause  disease that is severe enough that we will be required to have constant vaccination, like we do with the flu shots, like every year more, more likely. It can also go the other way. It could also, you know, the mutations could also make the virus less effective and causing maybe not so severe disease or mild disease, but we have to wait for that to happen, to know exactly what we're going to be into for the long run. But for now, I think that everything that David said I agree with, and I think that people just have to think about getting their booster shots or their third doses as soon as possible, because we still are learning about this new variant, specifically the one that's coming after delta. And we're hoping it's not going to be as severe as the delta variant, but we still don't know too much about it.

Bill Walsh: Okay, thank you, Dr. Eckardt, for that. Dr. Stewart, let's bring you into the conversation here. You know, this fall the CDC updated its list of underlying conditions that put people at higher risk for severe COVID-19. They added mood disorders to that list. And this is not a small number of people, at least 34 million Americans, that's 1 in 10, suffer from mood disorders. So why is it that people with mental health issues, even common mood disorders like depression or anxiety, are at higher risk for COVID-19 and what can be done about that?

Altha J. Stewart: Well, Bill, first thanks to AARP for bringing mental health and mental illnesses into this discussion. Often those are the areas that are not discussed when we're talking about what most people consider to be a general medical issue. And part of the answer to your question has to do with the general stigma that remains around mental health and mental illness. Persons who have mental illness are more likely to have shorter lifespans by up to 25 years, some studies suggest, than their counterparts without mental illness. And so in the face of something like the coronavirus and the pandemic and these variations that we are seeing, it becomes imperative for people who already are at risk for fewer contacts with the general medical system for their overall health care, whether it's hypertension or diabetes or more serious illnesses like various cancers and kidney disease and other things, they are then more susceptible if they do contract the virus to some of the worst outcomes because of their poor health going into having the virus. So when we think about people with mental illness and particularly mood disorders, you know, if you think about someone who's depressed, they are less likely to want to interact, they're less likely to want to follow up, they're less likely to want to be out and engaged, and more likely to say that whatever I'm feeling is probably related to my depression, as opposed to what may be the early symptoms of something like COVID. So we do have to pay special attention, and I think the mental health field in general is starting to pick up on the fact that if our patients are less likely to get general health care, then we really got to be assertive in making sure that, at a time like this in the midst of this pandemic, that we're focusing enough attention on making sure they've got the information and the access to getting what they need, whether it's the initial vaccine or the booster.

Bill Walsh: Okay, thanks so much for that, Dr. Stewart. Now I have a question for all of you, a quick question. You know, this is a confusing time. States and communities have different rules for mask wearing and social distances, and businesses are the same. And of course, it's impossible to know if someone you meet is vaccinated or not. So how do people navigate everyday activities, even if they're fully vaccinated? Are there some rules of thumb that we should follow to safely dine out, go to the theater or enjoy family during the holidays? Dr. Aronoff, do have some response for that?

David M. Aronoff: Well, it's a really great question. And I think independent of local rules or policies, which these SARS-CoV-2 viruses can't pay attention to or read, we need to remember that the fundamentals of how we reduce risk of getting COVID or spreading COVID are exactly the same today as they were a month ago or a year ago. And that means avoiding crowded indoor spaces unless we absolutely have to be in them. And if we're indoors with other people who we don't live with, that we should be wearing a face covering or a mask. We should not be going out if we're not feeling well, and we should make sure that we're vaccinated. And during this time of year, that means not only making sure that we're vaccinated or boosted against COVID, but also that we have our flu shot.

Bill Walsh: Okay. Dr. Stuart, did you want to add anything to that?

Altha J. Stewart: Yeah, we've developed three basic things that we encourage of people that they remain informed. That as new information comes up around things, that they integrate that into their way of behaving and thinking about how they're individually going to be dealing with the risk of the virus. That, as Dr. Aronoff said, it's about making you comfortable. So, if you want to go out and you're unsure of others, be clear to wear some kind of face covering and follow the general public health guidelines around social distancing and hand washing. And then finally, because this is psychologically so important in its contribution to developing anxiety and stress around these things, remember always that it's okay for you to do what makes you comfortable, even if it's with family who are, you know, on the fence about whether to vaccinate or not, it's about you being comfortable being around them.

Bill Walsh: Okay, and Dr. Eckardt?

Paula Eckardt: I would say I agree with all the panelists, but I think that we have to take into consideration a lot of people live in multigenerational homes, and we have, you know, people of different ages in the same household. And you may have different vaccination status of those people and taking care of the most vulnerable people in the house. If they're elderly or people that have all lot of comorbidities such as diabetes, COPD, things like that, and if, for example, there's a younger person in the house that might be vaccinated or not, that, you know, bring friends inside the house and we don't know the status of those people for vaccination, I think that's when we need to be very careful with our other members of our families when we don't know who is vaccinated or not, and avoid basically the indoor crowded spaces, but also situations like the one I told right now.

Bill Walsh: Okay, thanks to all our experts for that. And it couldn't come at a better time when families are gathering for the holidays. And we're going to get to those live questions in just a moment. But before we do, I want to bring in Nancy LeaMond. Nancy is the executive vice president and chief advocacy and engagement officer at AARP. Welcome, Nancy.

Nancy LeaMond: Delighted to be here, Bill. Thanks for having me.

Bill Walsh: Thanks for being here. We know it's been a busy time on Capitol Hill, and will continue to be, especially as it relates to legislation affecting older Americans. What's the latest news?

Nancy LeaMond: Well the Senate reconvened this week and we are closely monitoring what will happen with the Build Back Better Act. This is the bill the House passed last month, and it includes historic action to lower prescription drug prices. AARP has been fighting tooth and nail to stop unfair drug prices, and we're on the verge of seeing Congress finally take action. Right now, we're working hard to make sure that drug price provisions stay in the bill and that it clears the Senate.

Bill Walsh: So how would these new provisions help lower drug costs for older Americans?

Nancy LeaMond: Americans often pay two to three times as much for the same prescription drugs as citizens in other developed countries. And it's time to put a stop to it. The bill the House passed that's now in front of the Senate includes meaningful reforms to bring down medication costs. Medicare would finally be allowed to negotiate some drug prices. I can't stress enough how important that is. Also, drug companies would be penalized if they increase their prices faster than the rate of inflation. And there'd be a new annual cap on what seniors, who are enrolled in the Medicare Part D, pay out of pocket for their prescriptions, as well as a monthly cap on copayments for insulin. Now you may have seen drug company ads claiming this would limit access to prescription drugs, or that it's government price fixing. That's nonsense. These are scare tactics by big pharma, which has profited for years off overcharging American consumers. Don't believe it. Lowering prescription drug prices will make medicine more affordable and help all Americans.

Bill Walsh: Okay. Thanks for that update. Now, in addition to the federal government, a lot of the AARP advocacy happens at the state and local levels too. What are some of the priorities AARP takes on at the state level?

Nancy LeaMond: Well, as you said, AARP has offices in every state, and we spend a lot of time and effort fighting for positive change in state capitals in communities across the country. We're currently advocating for policies that protect and promote health and financial security for older Americans, things like expanded access to retirement savings plans, affordable health care and lower utility rates. We're also fighting for safe, accessible transportation and housing, as well as high speed internet access to help people stay connected.

Bill Walsh: Okay. Now, Nancy, one of the least discussed dimensions of the COVID pandemic has been in the setting where it has had the greatest impact. About 186,000 nursing home residents and staff have died from the virus, and that's nearly a quarter of all the COVID deaths in the U.S. What can be done to stop this?

Nancy LeaMond: What's happened in nursing homes is a national disgrace and AARP has been leading the charge to address it. We continue to urge elected officials at the federal and state levels to take action and make sure we don't see a repeat of needless deaths. We must ensure the public funds provided to nursing homes are used for vaccines, testing, proper staffing, and to improve the health and safety of residents. The pandemic brought to light problems that have plagued nursing homes for decades, including staffing shortages, poor infection control, transparency and accountability. AARP will continue to shine a light on what's happening in nursing homes and will push very, very hard for long-term reforms.

Bill Walsh: Okay. Nancy, thank you for those updates. And thanks so much for being here today.

Nancy LeaMond: Well, thanks for having me.

Bill Walsh: All right. It's now time to address your questions about the coronavirus with Dr. Aronoff, Dr. Stewart and Dr. Eckardt.

(Española)

Bill Walsh: Now I'd like to bring in my AARP colleague, Jesse Salinas, to help facilitate your calls today. Welcome, Jesse.

Jesse Salinas: So good to be here, Bill.

Bill Walsh: All right. Thank you. Who do we have first on the line?

Jesse Salinas: Our first call today is going to come from Cory in Illinois.

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

Cory: Hi, seeing that there's so many AARP people here, I'd love to ask a question about why AARP is tending to push seniors towards Medicare Advantage programs that are probably not appropriate, but this isn't really the venue for that. My question for this venue is, I, since the very beginning, there's been a lot of data about the Pfizer vaccine. And I understand that the Pfizer and Moderna are both mRNA vaccines, but we don't seem to get a lot of data about the effectiveness of the Moderna vaccine. And I'm wondering if the reason is just that it's a smaller company and they're doing less studies, or if there's something else causing that.

Bill Walsh: Well, let's ask one of our experts. Dr. Aronoff, do you want to take that one?

David M. Aronoff: Yeah, Cory, thank you for your question. I think that's a really important point. First of all, Pfizer generally has been a little bit ahead of Moderna in terms of starting and completing studies, getting their data in front of the FDA, and getting their data in front of the advisory committee on immunization practices, or ACIP, and getting out in terms of recommendations for public use just ahead of Moderna. But in fact, we do have lots of data now on both the safety and effectiveness of both mRNA vaccines. And clearly, they're both doing a lot of heavy lifting, they're working very, very well, and we know that boosting with either of those vaccines is also really, really quite safe and effective. But you know, remember also that the delay between the first dose and the second dose of Pfizer is three weeks, the delay that was used for the Moderna was four weeks. So that automatically baked in right out of the gates an additional week before people could be fully vaccinated with Moderna, and that contributed to some of the earlier delays in getting data from Moderna over Pfizer. But at this point we're really comfortable recommending both.

Bill Walsh: Okay. Thank you very much, Dr. Aronoff. Jesse, let's take another call.

Jesse Salinas: Our next call is going to be from Barbara in Utah.

Bill Walsh: Hey, Barbara, welcome to our program. Go ahead with your question.

Jesse Salinas: Okay, my question is, I have a granddaughter who works in a store, a big store and she's a cashier. Her husband and her son have COVID, and yet, because she isn't showing symptoms yet, they're making her go to work. Don't you, and she could stay home if she wanted, but that is without pay, and she is the breadwinner of the house because her husband was in a horrific motorcycle accident. So she has no choice but to go to work, and then she comes home and takes care of two very sick people. Do you think that there shouldn't be some kind of coverage that would let her stay home and take care of them and still get paid?

Bill Walsh: You know, that's a great question, and there's a lot of talk about paid leave in the legislation pending on Capitol Hill that Nancy LeaMond talked about. I wonder if one of our experts could address that? Dr. Stewart, do you have any insights on that?

Altha J. Stewart: Well, nothing specific on the issue of how to have her stay home and get paid. I think that's probably more in Nancy's wheelhouse in terms of policy, hopefully pending policy, to support some of these issues now that we're almost two years in. I would say that I'm certain that she has major concerns, both about her own possibility of contracting the virus, but also about the stress of being a caregiver. And as we know, AARP has some significant experience in caregiver support, and your granddaughter sounds like someone who would benefit from having a support network around her. And that, you're certainly a part of that from the fact that you asked the question. But also, that encouraging her to not feel that she is alone in doing this and to be able to ask for help to do all of the caregiving that she's required to do will certainly help support her. And maybe over time, we'll see some movement in that area of paid leave for caregivers of COVID patients.

Bill Walsh: Well, Dr. Eckardt, I wonder if you could weigh in on this as well. I mean, I've been reading a lot about advancements in treatments for people who have been diagnosed with COVID. Where are we with that, and would that offer some, you know, some relief and solace for Barbara's [grand-daughter and her husband]?

Paula Eckardt: Well it depends on the age and the risk factors that she has. Like, obviously she could be given monoclonal antibodies, but if, you know, for prevention. But the thing is, you know, obviously she has been exposed and every time she goes back home, she's exposed again. So, she's at very high risk of getting COVID, and so basically, she should get, you know, hopefully she already got tested. And you know, the recommendation is for her to not be in close contact with the people that are sick. Having said that, if she is unable to do that, and then I don't know about the work situation, but if she's unable to do that, you know, when she's getting in contact with them, she definitely should be wearing a mask, and the people that are sick should be wearing a mask and should be isolated in specific areas in the house where she's not, you know, in close contact with them. The sick people should be using their own bathrooms. That will be like the major recommendation. Obviously, you know, if she has to take care of them, then she has to take care of them, but we will always recommend to kind of quarantine if, you know, if she doesn't have to take care of them, like be also, you know, away from them. So, she wasn't getting infected, and infect other people.

Bill Walsh: Okay, thanks, thanks to both y'all. Let's take another question. Jesse.

Jesse Salinas: Yeah, we're going to try Clovis in Illinois.

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

Clovis: Yeah, now, man, my question is, my wife and I both have Johnson & Johnson shots, and we're hearing nothing about it. We're hearing a lot about Moderna and Pfizer, but we're hearing nothing about how good Johnson & Johnson is. Is it good or no good or what? But we're hearing a lot about Pfizer and Moderna.

Bill Walsh: Right. Have you gotten the booster as well? Or just the initial shot?

Jesse: No, I think we blocked him now.

Bill Walsh: Okay. Dr. Aronoff, I wonder if you could address the efficacy of the Johnson & Johnson vaccine?

David M. Aronoff: Yeah, I really appreciate Clovis's question because there are more data out there and more press around the mRNA vaccines. And the single dose J&J vaccine does seem to be waning a little bit more quickly than the two-dose mRNA vaccines, and in fact, that has translated into different recommendations about when to get booster shots. If people have had their initial vaccination with the mRNA vaccine, that would be Pfizer or Moderna, they should wait at least six months before they get their booster. But if somebody was a recipient of the single dose, J&J vaccine, to try to make sure that that immune response is as durable and protective as possible, the recommendation is that they get a booster starting two months after that single dose vaccine. After they get that booster shot, we don't have a lot of data, but the data that we do have suggests that it is quite protective. The question of how long that protection will be still remains to be determined. We don't have a lot of data yet about the protectiveness of the J&J vaccine against the new omicron variant. And so, there's some questions that still need to be answered, but a really, really good question by Clovis, and I hope that that answer helps a little.

Bill Walsh: Well, just a quick follow, I mean Clovis and his wife and others who took the J&J vaccine, should they get the J&J booster, or should they look for one of the others?

David M. Aronoff: Well, we don't have a firm answer to that. And in fact, that's reflected in the guidelines from the CDC who say, you know what? You can get whatever vaccine type you want. If you want to get a J&J single dose type of vaccine for your booster, you certainly can, but it's safe to mix and match. And so you can get an mRNA vaccine. Some data suggest that the mRNA vaccines are a bit more durable than the J&J vaccine, but we don't have a lot of data yet to guide us. What I'll say is that getting whatever booster someone can get is much, much more important than not getting boosted at all. And if we could get to the point where as many people as are eligible have had their first round of vaccines, that would be a significant success and the same for getting boosters. But for sure, it's okay to mix and match.

Bill Walsh: Okay, we're going to be talking more about that in just a few minutes. Let's go back to the phone lines. Jesse, who do we have on now?

Jesse Salinas: I'd like to bring on Chrissy from Florida.

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

Chrissy: Good afternoon. We'll be gathering like everyone, large family and many of them, about four of them travel all over the United States, out of the country. I know of one that's not vaccinated. Am I safe to just be wearing a mask? They’re more than willing, everyone, to wear a mask, but I have wondered if it can just be, I wear my mask, and then when I’m outside with my granddaughters, that I don’t have to wear a mask. We’re all, the granddaughters both have their first vaccinations and I’m going for my booster this week.

Bill Walsh: Okay, Dr. Eckardt, I wonder if you could talk about what steps Chrissy and the rest of her family should be taking when they gather for the holidays.

Paula Eckardt: Well, what I will recommend to someone in my family; if you are a high-risk patient, meaning you have other medical conditions, obviously, you know, older than 65. So it puts you at higher risk for COVID, for severe COVID. If you’re going to be in close contact with people that have potentially been exposed to COVID, and they are not vaccinated with the complete series, it might put you at higher risks. So, if that's what you guys decided that that's what you guys want to do, gather together, I will say everybody should be wearing masks including the people that are not vaccinated and the people that are partially vaccinated, just so they can, in case they are infected with COVID and not having any signs or symptoms of COVID, that they don't expose you. Because the whole point of wearing the mask is to prevent the person that is sick to get those droplets out in the space and then give it to other people. So, I think that it's important to think about that. Other things you could do is have them get tested right before the gathering. I know people don't like to do that, and sometimes they can't find places to get tested. And definitely, absolutely, if someone has a symptom, they should not be in there. Again, you know, I know that it is wintertime, but you know, if you're in Florida and you can do some gathering outside, I would suggest that that will be the best option.

Bill Walsh: All right, Dr. Eckardt, thanks so much for that. And thanks for all the questions from our listeners. We're going to take more of those questions soon.

(Española)

Bill Walsh: Let's turn back to our experts. Dr. Aronoff, for someone who was fully vaccinated six months ago, how much of the vaccine's potency has been lost and does a booster replace that waning effectiveness?

David M. Aronoff: Yeah, really, really great question, Bill. So, it depends a little bit on the exact vaccine, but in general, after about six months, probably about 40 percent of the protectiveness has been lost in terms of being vulnerable to getting symptomatic COVID. However, we don't lose that much effectiveness in terms of preventing hospitalizations or death. In fact, the vaccines seem to be pretty durable in terms of keeping people out of the hospital and saving lives. But the effectiveness against just getting symptomatically ill does seem to wane about 30 to 40 percent after six months, and the whole purpose of the boosters is exactly what your question suggests. The boosters restore and even augment our defenses against getting symptomatic COVID, against getting severe disease that might put us in the hospital, and restore our strength against even dying from COVID, and importantly, the original vaccines and the boosters make us harder to infect and harder to transmit the virus. So, by getting our booster shots, we’re not only providing better protection for ourselves, but we’re making it more likely that we will not be part of the chain of transmission that ends up giving the virus to somebody who might get very sick.

Bill Walsh: That’s a great point, Dr. Aronoff, and one that I don’t think is made enough about the potential of us transmitting the virus, even if we get the vaccine. So thank you for that. I’d like to turn back to Dr. Stewart right now. You know this year has been so topsy-turvy. Early this summer, it seemed like we were returning to normal, and then the delta variant set us all back. Now the threat of omicron is lurking out there. What is the impact of all of this volatility on our mental health and how detrimental is it?

Altha J. Stewart: Well, you know, that’s an excellent way to describe it. Topsy- turvy, roller coaster, hills and valleys. You know, I’ve heard all kinds of permutations of the ups and downs that we’ve endured over the last couple of years with respect to COVID. And I guess it, for me as a psychiatrist, this plays out in a couple of ways. We’re all aware that we have, each of us, been affected in some way by this kind of topsy-turvy, as you described it, relationship now that we have with this virus and through the pandemic. And so, there is the possibility and the risk that some will let down their guards because that up and down, up and down, hill and valley perspective can be very wearing and exhausting. That's the other word I've heard a lot over the last year and a half — exhausting, individually and societally. And so, we have to forever and always be on guard, I think, about getting too complacent during the good times so that we aren't able to reenergize and get back into the habits of safety that we need during those times when delta or omicron or whatever other variant may appear. When those things happen, we've got to be able to gear back up to be our, at our highest level of vigilance around our own health and safety, as well as that of those around us. There is also the possibility that people kind of get into a whatever. You know, I did all of that stuff, and I came through okay with the last year and a half, and now the delta, and I've made it through that, and now omicron, and it's just going to keep happening and happening, so why bother taking any steps to be safe and protect myself and others. And we can't allow that to be the prevailing theme in our lives either. So, finding something positive, I know I've spoken on other shows about each day trying to find something positive to get you into the spirit of, I'm in control of some things, but not everything. And whether, you know, whether that's how you socialize with family and friends in a safe manner, of course, but that you reconnect with each other. What returning to work may mean for some. What heightened levels of awareness around the virus may mean for others. That there are those things that we can do something about, be in control of, and use as guides to keep us focused on what's positive in our lives. We can't control, you know, the mutations of the virus, we can't control if we'd been around someone who may in fact be infected and passed it on, but what we can control is how we generally handle ourselves during this, and that we remain vigilant to understanding that depression, anxiety, stress, all of those things have happened to each of us in some way, shape or form over the last year and a half, and that it's okay to say, today I'm not okay, and to ask for help.

Bill Walsh: Great advice. Thanks so much for that, Dr. Stewart. Dr. Eckardt, you know, a few moments ago, one of our listeners was asking about the effectiveness of one of the vaccines and we started talking about mixing them. What advice can you offer about mixing vaccines? Are there any benefits to it? And of course, we're in the midst of flu season. Is there any risk of getting the COVID vaccine at the same time you get others such as flu vaccines, DTap?

Paula Eckardt: I think we know more now, and we feel more comfortable mixing the vaccines that, you know, in the past we didn't have the information. So our practice now is to, you know, if you can get the original vaccine that you got, you know, good. Get that one as a booster. If you can't get it or it's not available, then you can mix it. For example, you've got the Pfizer series, then you can get a Moderna booster. And a lot of my patients have already done that, and we haven't seen any problems with that. So, I think that's important to know. Also with the flu season, at the beginning there was a recommendation to wait at least two weeks between, you know, vaccines. But right now the recommendation is to, you know, get the vaccines. You can get them at the same time. Actually myself, I got at the same time with no problems. So, I think that people should be vigilant that we are, you know, in the wintertime, and this is when we see a lot of those respiratory infections and we still can't see influenza, and influenza every year strikes a lot of people and end up in the hospital and some people ended up dying. So, I think it's important to continue to vaccinate for those and get their booster for COVID.

Bill Walsh: Thanks for that, Dr. Eckardt. Now it's time to address more of your questions with Dr. Aronoff, Dr. Stewart and Dr. Eckardt. Jessie, who do we have next on the line?

Jesse Salinas: Yeah, Bill, on the next one, we're going to take a question from YouTube. I've got a question from Lisa on Facebook and she's saying, "This pandemic has had her having issues staying connected to people, right, with social distancing and such, and now Medicare is not accepting her mental health therapists." Are there options to help her keep her therapist or to help her find a new one.

Bill Walsh: Dr. Stewart, you seem ideally positioned to answer that question from Lisa.

Altha J. Stewart: Yes. and thank you, Lisa, for that question. Unfortunately, there's no individualized answer that I can offer because these are the kinds of issues that are really regional and state and sometimes locally specific. In general, there are a couple of things that I would advise, that you work very closely with the therapist to assure that you have done all of the necessary or taken all of the necessary steps. If there is a question that it is going to be prohibited, that you've done everything along with the therapist to appeal those decisions using the justification and grounds that lead you both to believe that staying connected is in your best interest from a health care perspective. The other thing is that you and the therapist both need to explore what is available in your area in the form of support from your providers, depending on the discipline, their particular focus on advocating for care in your area. And that you are aware of what various consumer groups are also doing in support of assuring those things stay intact, those relationships stay intact. There's an awful lot of activity by providers and consumer organizations during this time of topsy-turvy, that are being seen as effective in many areas. The expansion of tele-health as a means of staying connected and those things are a direct result of providers and consumers ensuring that the message is very clear that this is an important time for there to be no breaks in those kinds of relationships. So do all of those things and I regret I don't have more specific guidance on how to do it, but that will get you started in terms of advocating for what you need and good luck.

Bill Walsh: All right, Dr. Stewart. Thanks so much for that. Jesse, who's up next?

Jesse Salinas: I'm going to take another one from YouTube, Bill. This is, her name is Edna, and she says, "We're terrified about the vaccine having material that might be dangerous to older people, and for that reason, I've not had, gotten my shot. Is there any truth to what I've been seeing online?"

Bill Walsh: Dr. Aronoff, I wonder if you can address those concerns. We're hearing a lot of, I would say, myths out there about what's in the vaccine and what isn't. Can you set the record straight?

David M. Aronoff: Sure, and I want to thank Edna for that question. And I think the question really does a good job of helping us think through the fact that people who have not yet been vaccinated often have very different concerns. And an important one that we hear over and over is questions about safety. We now know that these vaccines went through the usual clinical studies — phase 1, phase 2, and large phase 3 studies with tens of thousands of people — and did not show any unexpected safety problems. And now we've used the vaccines worldwide in about, I think we've given about 8 billion doses. In the United States, we've given almost 500 million doses; I think we're at about 470 million doses of these vaccines. And we've been able to do that under the watchful eye of every person who has received the vaccine, every person who has delivered the vaccines, and the usual oversight bodies like the FDA and the CDC. And we just, you know, we really have very, very good data to show that in older adults, these vaccines are very safe and very effective. People get sore arms. They can have fatigue and fever and feel under the weather for a few days after getting vaccinated, and we're now kind of used to the fact that those are possibilities, but that's often just our immune system responding to the vaccine. So, you know, the ingredients that are in the vaccine include the part, the business end of the vaccine that's meant to train our immune system on the COVID virus to prevent infection, and then things that are important to keep the vaccine stable until it can do its job. But these are ingredients that are used in lots of medicines, used in other vaccines, and we have a long track record with their safety. So I appreciate Edna's question. If there are rumors out there about these vaccines being dangerous for older people, that is mythology.

Bill Walsh: Yeah. And Dr. Aronoff, I mean, you talked about what's in the vaccine. I think it's important to also talk about what's not in it, which is the live virus, right?

David M. Aronoff: Super-important point, Bill, and I'm glad that you brought that up. These vaccines that we're using are not the live SARS-CoV-2 virus. They are really designed to train our immune system on one part of the virus, which is called the spike protein, which is a little bit like the Velcro on the outer surface of the virus that's important for the virus to set up infection in us. And so these vaccines have ingredients that help instruct our immune response against the spike protein, but they are not including any live virus at all.

Bill Walsh: Okay, thanks so much for that. Jesse, who do we have next?

Jesse Salinas: Yeah, our next question is going to come from Tom in Wisconsin.

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

Tom: Hi, my question is, I've had the three shots. I'm a high-risk person, and what is the, will I be able to pick up anything from this, from this point on? That was my question, and then one other question was, what are we doing about our, the nurses and doctors that are so overwhelmed with the work that they've got in front of them?

Bill Walsh: Hmm. Those are, those are some great questions, Tom. Dr. Eckardt, you know, Tom's gotten three shots. It sounds like he's at high risk. How much does he have to worry about contracting COVID-19 at this point?

Paula Eckardt: I think everybody has to look at the area where they're at right now, if there's a lot of COVID in their area, if there's an outbreak going on right now in the area. So you will be at higher risk if you are there. If you got your third shot, and you're not an immunocompromised person, meaning you're not a cancer patient or somebody that is using medications to decrease your immune system, most likely the vaccines are effective, and they will protect you from severe disease. There are, here and there, cases where even though everybody gets all the vaccines that they get, they're supposed to get, they still got the disease, and could end up in the hospital, but the possibility is less likely for those that got the booster shot. And I do want to say something about the physician burnout and what's happening with the health care epidemic of, you know, being tired of this. So, we've been battling COVID since March 7th, 2020, at my hospital, and I think that there have been so many good things that came from it, and specifically, support from, you know, the administration in the sense that we have a lot of mental health support, and we can reach out when we are tired. But nevertheless, when we have those surges, it is a little bit tough and you just have to, like Dr. Stewart was saying, like every day just think positive that, you know, one day at a time and that we are going to be fine. And I think that we now have more armamentarium to treat our patients and in the beginning we didn't. So it was very frustrating. So right now, even though we still have some patients that do complicate and end up dying, we feel more confident in the way we treat the patients and the way our system is responding to the pandemic, especially now that we have the vaccine.

Bill Walsh: Thanks so much for that, Dr. Eckardt. Jesse, who do we have next on the line?

Jesse Salinas: Our next call is Dale from New Mexico.

Bill Walsh: Hey, Dale, welcome to our program. Go ahead with your question.

Dale: My question is, does the body build up an antibody to the virus if you have a case of the virus, no matter how mild?

Bill Walsh: Right. Interesting question and much discussed. Dr. Aronoff, can you talk about that and how long any protection might last.

David M. Aronoff: Yeah, Dale raises a really important question. First of all, with vaccination, one of the advantages of vaccination over depending on natural sort of infection to boost our immune system is that vaccinations give us a very standard, strong, specific and safe immune response against the SARS-CoV-2 virus. The question that Dale really asks is, after an infection, what happens to our immune response? And it is clear that people who have asymptomatic COVID, which is a strikingly large number of people, may not get a strong immune response compared to someone who is severely ill or quite symptomatic. In fact, the stronger the symptoms are, generally the stronger the immune response is. And that's been now shown in many studies. And so, if somebody didn't know they had COVID, but they get a test that shows that they have COVID, in other words, they've had asymptomatic COVID, it is really hard to know what to tell them about how protected they are against getting reinfected. And it is likely that that protection would wane more quickly than if they had had a severe illness, which we would never wish on someone. Vaccination takes care of this problem by giving us the same dose that gives us a very predictable, strong immune response in a much safer way than depending on infection. So I hope that that helps with Dale's question.

Bill Walsh: Yeah, thanks so much for that, Dr. Aronoff. I appreciate it. Jesse, who do we have next on the line?

Jesse Salinas: We're going to bring Winona from Missouri on.

Bill Walsh: Hey, Winona, welcome to our program. Go ahead with your question.

Winona: Thank you for taking my question. Last week my granddaughter tested positive for the COVID-19, and I was, you know, staying at her house. So, I went last Friday and had the test, and they said that I didn't, that I was negative. But after that I've gotten ill, and I'm just kind of getting over it. I did, I had a temperature a couple of times. I didn't have any headaches. I had a cough and I still kind of got a cough now. So, I was planning on going to have a test again today. So I just wondered, is it too close to have the test again today? Or is it all right to go? And what about I have, I've had my two shots and I've also had the flu shot.

Bill Walsh: Okay. And when did you say you had your last COVID test, Winona?

Winona: I had it last Friday.

Bill Walsh: Got it. Okay. Let's ask one of our experts. Dr. Eckert, what do you suggest for Winona?

Paula Eckardt: Well, with the delta variant we were always suggesting to test three to five days after the exposure. So, I think that if she just got tested last Friday and the exposure was before that she could definitely get tested right now. I think it's actually very important for her to get tested to make sure with the symptoms that she's telling us, that she's, you know, doesn't have COVID, so she can either get monoclonal antibodies or get another evaluation. Also, she needs to make sure that she's not infected. And I think she was asking about also when she can get the booster. So, if she is infected right now, she will need to wait until she's no longer infectious. So, usually it's around 10 days after the first symptoms started, depending on the severity of disease, but it's usually 10 days. And then after that she could potentially get her booster. If she gets monoclonal antibodies for, you know, because she has a mild disease and her doctor recommends that, then the delay on the vaccine might be for 90 days. But definitely need to contact your health care provider and decide on getting a test as soon as possible.

Bill Walsh: Okay, Dr. Eckardt, thank you so much for that. And thanks to all of our experts for being with us. Today has been a really informative discussion. I'm going to also thank you, our AARP members, volunteers and listeners, for participating in the discussion today. AARP, a nonprofit, nonpartisan membership organization, has been working to promote the health and well-being of older Americans for more than 60 years. 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, December 10th. Again, that address is aarp.org/coronavirus. 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 next week, December 16th, at 7 p.m. Eastern Time for a special Tele-Town Hall featuring Dr. Francis Collins, the director of the National Institutes of Health. He will give us the latest on the virus and the vaccines and take your questions live. We hope you can join us. Thank you and have a good day. This concludes our call.

[00:00:00] Bill Walsh: Hello, I'm 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 *0 on your telephone keypad now.

[00:00:16] [Española]

[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. In the face of the global coronavirus pandemic, AARP is providing information and resources to help older adults and those caring for them. You know, it seemed just a month ago that things were beginning to return to normal. But the emergence of the omicron variant has rekindled concerns for many Americans as they prepare to gather for the holidays. While increasing COVID vaccination rates give us some comfort, we know that vaccine protection erodes over time and some 100 million Americans who are eligible for booster shots still haven't gotten them. Meanwhile, on the political front, Congress could be on the cusp of passing historical legislation that could finally lower the drug costs for Americans.

[00:01:16] Today we'll hear from an impressive panel of experts about these issues and more, and next week, we'll host a special event with Dr. Francis Collins, head of the National Institutes of Health. 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 coronavirus pandemic, press *3 on your telephone, and you'll 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.

[00:02:21] We have some outstanding guests joining us today, including two infectious disease experts and a mental health expert. We'll also be joined by my AARP colleague, Jesse Salinas, who will help facilitate your calls today. This event is being recorded and you can access the recording at aarp.org/coronavirus 24 hours after we wrap up.

[00:02:59] Now I'd like to welcome our guests. David M. Aronoff, M.D., is director in the Division of Infectious Diseases and the Department of Medicine at Vanderbilt University Medical Center. Welcome back to the program, Dr. Aronoff.

[00:03:14] David M. Aronoff: Great to be here. Thank you for having me.

[00:03:15] Bill Walsh: All right. We're delighted to have you back. Altha J. Stewart, M.D., is a senior associate dean for Community Health Engagement and associate professor and director in the Division of Social and Community Psychiatry at the University of Tennessee Health Science Center. Welcome back to the program, Dr. Stewart.

[00:03:34] Altha J. Stewart: Thank you, Bill, a pleasure to be with you again.

[00:03:36] Bill Walsh: All right. And Paula Eckardt, M.D., is the chief in the Memorial Division of Infectious Disease at Memorial Healthcare System. Welcome to the program, Dr. Eckardt.

[00:03:47] Paula Eckardt: Thank you for inviting me.

[00:03:49] Bill Walsh: All right. Thanks all of you for being here. Let's go ahead and get started. Dr. Aronoff, there were some restrictions at the outset about who is eligible for COVID boosters, but now eligibility has been expanded. Can you talk about who is eligible and why has the booster dose become such a priority? And maybe you could also address how effective the vaccines are against omicron.

[00:04:27] David M. Aronoff: Sure, well again, Bill, thank you for having me, and it's an honor to be on with these guests. You know, you're exactly right, we were somewhat staging how we were using boosters, but now they are recommended for anybody over the age of 18 who has already completed the first round of vaccination. If people got the mRNA vaccines, which are offered by Pfizer or Moderna, then they should wait at least six months and then they are eligible for a booster. And if they received the J&J single dose vaccine then after two months have gone by from that vaccination, they are eligible for boosters. You know, we have certainly seen that the vaccines can wane over time in terms of being vulnerable to getting COVID-19. And we're seeing the rise of this variant that goes by the name omicron, that seems to be quite contagious, and we want to make sure that we have the best defenses up against this variant to keep us out of the hospital and to make sure that as few people as possible get sick. And so, we're really urging that now is the time, if you're eligible, to get that booster done.

[00:05:47] Bill Walsh: And do we have any information on the effectiveness of the vaccines against omicron? I know it's still early days in that regard.

[00:05:56] David M. Aronoff: Yeah, so there's been data from two different sources. One is in the laboratory, in a Petri dish basically, where we can take people's blood after they've been vaccinated and see if the antibodies in their blood can block the virus, in this case the omicron variant, from infecting human cells in a petri dish. And there are data that suggests that after the initial vaccination that our antibodies don't do as well blocking the omicron virus in a petri dish compared to blocking the delta variant or the original variant. However, we very recently learned from data from Pfizer that after a booster dose, those antibody levels in our blood are high enough that, at least in a petri dish in a laboratory, they do effectively block the omicron virus from causing infection. What we don't really know is the effect of these vaccinations out in the real world against the omicron variant. There are some suggestions that people who are vaccinated are protected against getting severe disease, but it's very, very early days still. And I think there's a lot more that we need to learn, but we even learned very recently that the FDA has approved giving a Pfizer booster to 16- and 17-year-olds. And I think the urgency here is that we really want to make sure that as omicron spreads, that we get as much benefit out of available vaccines as we possibly can.

[00:07:33] Bill Walsh: Let me follow up on that, Dr. Aronoff. I mean, given the effectiveness of the vaccines in protecting against COVID or at least minimizing its severity, why do you think we haven't seen faster uptake of the booster shots? I mean, what's the message that the hundred million or so people who are eligible for a booster need to hear?

[00:07:53] David M. Aronoff: Well, certainly people are going to get boosters, which is fantastic, and I certainly would urge anybody tuned in today to, if you're eligible, to go get boosters. They're free, they're readily available. You know, there's a lot of factors in understanding why people haven't yet gone out to get their booster. Some of it is not knowing where to get the boosters. Questions about whether people are eligible or available for getting boosters. And then, of course, there's fatigue around the issue of, gosh, I've already had two shots, or I've already got vaccinated, they seem to be protecting, do I really need to get this other shot? People are getting flu shots and they may think, you know, I'm just going to wait and see. But as mentioned, these vaccines are not only effective at preventing complications of COVID, but they're also very, very safe, and that can be a concern. Somebody says, "I've had my initial vaccines. What if, when I get my booster, I get a bad reaction?" And what the data are clearly showing us is that the booster shots don't cause worse reactions than the initial vaccines, but we need to be really good at getting that message out.

[00:09:03] Bill Walsh: Okay, thank you, Dr. Aronoff. Dr. Eckhardt, let's turn to you and talk about these variants. I feel like we're all learning the Greek alphabet for the very worst reasons. But, of course, as we know the COVID-19 virus continues to mutate, which is why we've seen variants like delta and omicron, and perhaps others. Will that mutation continue indefinitely? And are more boosters likely? I'm wondering if they're going to become ultimately as routine as a flu shot.

[00:09:33] Paula Eckardt: Well, that's one of the possibilities is that it will continue to mutate and cause disease that is severe enough that we will be required to have constant vaccination, like we do with the flu shots, like every year more, more likely. It can also go the other way. It could also, you know, the mutations could also make the virus less effective and causing maybe not so severe disease or mild disease, but we have to wait for that to happen, to know exactly what we're going to be into for the long run. But for now, I think that everything that David said I agree with, and I think that people just have to think about getting their booster shots or their third doses as soon as possible, because we still are learning about this new variant, specifically the one that's coming after delta. And we're hoping it's not going to be as severe as the delta variant, but we still don't know too much about it.

[00:10:39] Bill Walsh: Okay, thank you, Dr. Eckardt, for that. Dr. Stewart, let's bring you into the conversation here. You know, this fall the CDC updated its list of underlying conditions that put people at higher risk for severe COVID-19. They added mood disorders to that list. And this is not a small number of people, at least 34 million Americans, that's 1 in 10, suffer from mood disorders. So why is it that people with mental health issues, even common mood disorders like depression or anxiety, are at higher risk for COVID-19 and what can be done about that?

[00:11:17] Altha J. Stewart: Well, Bill, first thanks to AARP for bringing mental health and mental illnesses into this discussion. Often those are the areas that are not discussed when we're talking about what most people consider to be a general medical issue. And part of the answer to your question has to do with the general stigma that remains around mental health and mental illness. Persons who have mental illness are more likely to have shorter lifespans by up to 25 years, some studies suggest, than their counterparts without mental illness. And so in the face of something like the coronavirus and the pandemic and these variations that we are seeing, it becomes imperative for people who already are at risk for fewer contacts with the general medical system for their overall health care, whether it's hypertension or diabetes or more serious illnesses like various cancers and kidney disease and other things, they are then more susceptible if they do contract the virus to some of the worst outcomes because of their poor health going into having the virus. So when we think about people with mental illness and particularly mood disorders, you know, if you think about someone who's depressed, they are less likely to want to interact, they're less likely to want to follow up, they're less likely to want to be out and engaged, and more likely to say that whatever I'm feeling is probably related to my depression, as opposed to what may be the early symptoms of something like COVID. So we do have to pay special attention, and I think the mental health field in general is starting to pick up on the fact that if our patients are less likely to get general health care, then we really got to be assertive in making sure that, at a time like this in the midst of this pandemic, that we're focusing enough attention on making sure they've got the information and the access to getting what they need, whether it's the initial vaccine or the booster.

[00:13:29] Bill Walsh: Okay, thanks so much for that, Dr. Stewart. Now I have a question for all of you, a quick question. You know, this is a confusing time. States and communities have different rules for mask wearing and social distances, and businesses are the same. And of course, it's impossible to know if someone you meet is vaccinated or not. So how do people navigate everyday activities, even if they're fully vaccinated? Are there some rules of thumb that we should follow to safely dine out, go to the theater or enjoy family during the holidays? Dr. Aronoff, do have some response for that?

[00:14:05] David M. Aronoff: Well, it's a really great question. And I think independent of local rules or policies, which these SARS-CoV-2 viruses can't pay attention to or read, we need to remember that the fundamentals of how we reduce risk of getting COVID or spreading COVID are exactly the same today as they were a month ago or a year ago. And that means avoiding crowded indoor spaces unless we absolutely have to be in them. And if we're indoors with other people who we don't live with, that we should be wearing a face covering or a mask. We should not be going out if we're not feeling well, and we should make sure that we're vaccinated. And during this time of year, that means not only making sure that we're vaccinated or boosted against COVID, but also that we have our flu shot.

[00:14:56] Bill Walsh: Okay. Dr. Stuart, did you want to add anything to that?

[00:14:59] Altha J. Stewart: Yeah, we've developed three basic things that we encourage of people that they remain informed. That as new information comes up around things, that they integrate that into their way of behaving and thinking about how they're individually going to be dealing with the risk of the virus. That, as Dr. Aronoff said, it's about making you comfortable. So, if you want to go out and you're unsure of others, be clear to wear some kind of face covering and follow the general public health guidelines around social distancing and hand washing. And then finally, because this is psychologically so important in its contribution to developing anxiety and stress around these things, remember always that it's okay for you to do what makes you comfortable, even if it's with family who are, you know, on the fence about whether to vaccinate or not, it's about you being comfortable being around them.

[00:15:57] Bill Walsh: Okay, and Dr. Eckardt?

[00:16:00] Paula Eckardt: I would say I agree with all the panelists, but I think that we have to take into consideration a lot of people live in multigenerational homes, and we have, you know, people of different ages in the same household. And you may have different vaccination status of those people and taking care of the most vulnerable people in the house. If they're elderly or people that have all lot of comorbidities such as diabetes, COPD, things like that, and if, for example, there's a younger person in the house that might be vaccinated or not, that, you know, bring friends inside the house and we don't know the status of those people for vaccination, I think that's when we need to be very careful with our other members of our families when we don't know who is vaccinated or not, and avoid basically the indoor crowded spaces, but also situations like the one I told right now.

[00:16:56] Bill Walsh: Okay, thanks to all our experts for that. And it couldn't come at a better time when families are gathering for the holidays. And we're going to get to those live questions in just a moment. But before we do, I want to bring in Nancy LeaMond. Nancy is the executive vice president and chief advocacy and engagement officer at AARP. Welcome, Nancy.

[00:17:22] Nancy LeaMond: Delighted to be here, Bill. Thanks for having me.

[00:17:24] Bill Walsh: Thanks for being here. We know it's been a busy time on Capitol Hill, and will continue to be, especially as it relates to legislation affecting older Americans. What's the latest news?

[00:17:37] Nancy LeaMond: Well the Senate reconvened this week and we are closely monitoring what will happen with the Build Back Better Act. This is the bill the House passed last month, and it includes historic action to lower prescription drug prices. AARP has been fighting tooth and nail to stop unfair drug prices, and we're on the verge of seeing Congress finally take action. Right now, we're working hard to make sure that drug price provisions stay in the bill and that it clears the Senate.

[00:18:09] Bill Walsh: So how would these new provisions help lower drug costs for older Americans?

[00:18:15] Nancy LeaMond: Americans often pay two to three times as much for the same prescription drugs as citizens in other developed countries. And it's time to put a stop to it. The bill the House passed that's now in front of the Senate includes meaningful reforms to bring down medication costs. Medicare would finally be allowed to negotiate some drug prices. I can't stress enough how important that is. Also, drug companies would be penalized if they increase their prices faster than the rate of inflation. And there'd be a new annual cap on what seniors, who are enrolled in the Medicare Part D, pay out of pocket for their prescriptions, as well as a monthly cap on copayments for insulin. Now you may have seen drug company ads claiming this would limit access to prescription drugs, or that it's government price fixing. That's nonsense. These are scare tactics by big pharma, which has profited for years off overcharging American consumers. Don't believe it. Lowering prescription drug prices will make medicine more affordable and help all Americans.

[00:19:25] Bill Walsh: Okay. Thanks for that update. Now, in addition to the federal government, a lot of the AARP advocacy happens at the state and local levels too. What are some of the priorities AARP takes on at the state level?

[00:19:39] Nancy LeaMond: Well, as you said, AARP has offices in every state, and we spend a lot of time and effort fighting for positive change in state capitals in communities across the country. We're currently advocating for policies that protect and promote health and financial security for older Americans, things like expanded access to retirement savings plans, affordable health care and lower utility rates. We're also fighting for safe, accessible transportation and housing, as well as high speed internet access to help people stay connected.

[00:20:12] Bill Walsh: Okay. Now, Nancy, one of the least discussed dimensions of the COVID pandemic has been in the setting where it has had the greatest impact. About 186,000 nursing home residents and staff have died from the virus, and that's nearly a quarter of all the COVID deaths in the U.S. What can be done to stop this?

[00:20:35] Nancy LeaMond: What's happened in nursing homes is a national disgrace and AARP has been leading the charge to address it. We continue to urge elected officials at the federal and state levels to take action and make sure we don't see a repeat of needless deaths. We must ensure the public funds provided to nursing homes are used for vaccines, testing, proper staffing, and to improve the health and safety of residents. The pandemic brought to light problems that have plagued nursing homes for decades, including staffing shortages, poor infection control, transparency and accountability. AARP will continue to shine a light on what's happening in nursing homes and will push very, very hard for long-term reforms.

[00:21:22] Bill Walsh: Okay. Nancy, thank you for those updates. And thanks so much for being here today.

[00:21:28] Nancy LeaMond: Well, thanks for having me.

[00:21:29] Bill Walsh: All right. It's now time to address your questions about the coronavirus with Dr. Aronoff, Dr. Stewart and Dr. Eckardt.

[00:21:37] [Española]

[00:21:59] Now I'd like to bring in my AARP colleague, Jesse Salinas, to help facilitate your calls today. Welcome, Jesse.

[00:22:06] Jesse Salinas: So good to be here, Bill.

[00:22:08] Bill Walsh: All right. Thank you. Who do we have first on the line?

[00:22:12] Jesse Salinas: Our first call today is going to come from Cory in Illinois.

[00:22:17] Bill Walsh: Hey, Cory, welcome to the program. Go ahead with your question.

[00:22:21] Cory: Hi, seeing that there's so many AARP people here, I'd love to ask a question about why AARP is tending to push seniors towards Medicare Advantage programs that are probably not appropriate, but this isn't really the venue for that. My question for this venue is, I, since the very beginning, there's been a lot of data about the Pfizer vaccine. And I understand that the Pfizer and Moderna are both mRNA vaccines, but we don't seem to get a lot of data about the effectiveness of the Moderna vaccine. And I'm wondering if the reason is just that it's a smaller company and they're doing less studies, or if there's something else causing that.

[00:23:00] Bill Walsh: Well, let's ask one of our experts. Dr. Aronoff, do you want to take that one?

[00:23:05] David M. Aronoff: Yeah, Cory, thank you for your question. I think that's a really important point. First of all, Pfizer generally has been a little bit ahead of Moderna in terms of starting and completing studies, getting their data in front of the FDA, and getting their data in front of the advisory committee on immunization practices, or ACIP, and getting out in terms of recommendations for public use just ahead of Moderna. But in fact, we do have lots of data now on both the safety and effectiveness of both mRNA vaccines. And clearly, they're both doing a lot of heavy lifting, they're working very, very well, and we know that boosting with either of those vaccines is also really, really quite safe and effective. But you know, remember also that the delay between the first dose and the second dose of Pfizer is three weeks, the delay that was used for the Moderna was four weeks. So that automatically baked in right out of the gates an additional week before people could be fully vaccinated with Moderna, and that contributed to some of the earlier delays in getting data from Moderna over Pfizer. But at this point we're really comfortable recommending both.

[00:24:30] Bill Walsh: Okay. Thank you very much, Dr. Aronoff. Jesse, let's take another call.

[00:24:34] Jesse Salinas: Our next call is going to be from Barbara in Utah.

[00:24:38] Bill Walsh: Hey, Barbara, welcome to our program. Go ahead with your question.

[00:24:43] Jesse Salinas: Okay, my question is, I have a granddaughter who works in a store, a big store and she's a cashier. Her husband and her son have COVID, and yet, because she isn't showing symptoms yet, they're making her go to work. Don't you, and she could stay home if she wanted, but that is without pay, and she is the breadwinner of the house because her husband was in a horrific motorcycle accident. So she has no choice but to go to work, and then she comes home and takes care of two very sick people. Do you think that there shouldn't be some kind of coverage that would let her stay home and take care of them and still get paid?

[00:25:36] Bill Walsh: You know, that's a great question, and there's a lot of talk about paid leave in the legislation pending on Capitol Hill that Nancy LeaMond talked about. I wonder if one of our experts could address that? Dr. Stewart, do you have any insights on that?

[00:25:53] Altha J. Stewart: Well, nothing specific on the issue of how to have her stay home and get paid. I think that's probably more in Nancy's wheelhouse in terms of policy, hopefully pending policy, to support some of these issues now that we're almost two years in. I would say that I'm certain that she has major concerns, both about her own possibility of contracting the virus, but also about the stress of being a caregiver. And as we know, AARP has some significant experience in caregiver support, and your granddaughter sounds like someone who would benefit from having a support network around her. And that, you're certainly a part of that from the fact that you asked the question. But also, that encouraging her to not feel that she is alone in doing this and to be able to ask for help to do all of the caregiving that she's required to do will certainly help support her. And maybe over time, we'll see some movement in that area of paid leave for caregivers of COVID patients.

[00:27:07] Bill Walsh: Well, Dr. Eckardt, I wonder if you could weigh in on this as well. I mean, I've been reading a lot about advancements in treatments for people who have been diagnosed with COVID. Where are we with that, and would that offer some, you know, some relief and solace for Barbara's [grand-daughter and her husband] ?

[00:27:27] Paula Eckardt: Well it depends on the age and the risk factors that she has. Like, obviously she could be given monoclonal antibodies, but if, you know, for prevention. But the thing is, you know, obviously she has been exposed and every time she goes back home, she's exposed again. So, she's at very high risk of getting COVID, and so basically, she should get, you know, hopefully she already got tested. And you know, the recommendation is for her to not be in close contact with the people that are sick. Having said that, if she is unable to do that, and then I don't know about the work situation, but if she's unable to do that, you know, when she's getting in contact with them, she definitely should be wearing a mask, and the people that are sick should be wearing a mask and should be isolated in specific areas in the house where she's not, you know, in close contact with them. The sick people should be using their own bathrooms. That will be like the major recommendation. Obviously, you know, if she has to take care of them, then she has to take care of them, but we will always recommend to kind of quarantine if, you know, if she doesn't have to take care of them, like be also, you know, away from them. So, she wasn't getting infected, and infect other people.

[00:28:48] Bill Walsh: Okay, thanks, thanks to both y'all. Let's take another question. Jesse.

[00:28:55] Jesse Salinas: Yeah, we're going to try Clovis in Illinois.

[00:28:58] Bill Walsh: Hey, Clovis, welcome to the program. Go ahead with your question.

[00:29:03] Clovis: Yeah, now, man, my question is, my wife and I both have Johnson & Johnson shots, and we're hearing nothing about it. We're hearing a lot about Moderna and Pfizer, but we're hearing nothing about how good Johnson & Johnson is. Is it good or no good or what? But we're hearing a lot about Pfizer and Moderna.

[00:29:25] Bill Walsh: Right. Have you gotten the booster as well? Or just the initial shot?

[00:29:29] Jesse: No, I think we blocked him now.

[00:29:32] Bill Walsh: Okay. Dr. Aronoff, I wonder if you could address the efficacy of the Johnson & Johnson vaccine?

[00:29:39] David M. Aronoff: Yeah, I really appreciate Clovis's question because there are more data out there and more press around the mRNA vaccines. And the single dose J&J vaccine does seem to be waning a little bit more quickly than the two-dose mRNA vaccines, and in fact, that has translated into different recommendations about when to get booster shots. If people have had their initial vaccination with the mRNA vaccine, that would be Pfizer or Moderna, they should wait at least six months before they get their booster. But if somebody was a recipient of the single dose, J&J vaccine, to try to make sure that that immune response is as durable and protective as possible, the recommendation is that they get a booster starting two months after that single dose vaccine. After they get that booster shot, we don't have a lot of data, but the data that we do have suggests that it is quite protective. The question of how long that protection will be still remains to be determined. We don't have a lot of data yet about the protectiveness of the J&J vaccine against the new omicron variant. And so, there's some questions that still need to be answered, but a really, really good question by Clovis, and I hope that that answer helps a little.

[00:31:02] Bill Walsh: Well, just a quick follow, I mean Clovis and his wife and others who took the J&J vaccine, should they get the J&J booster, or should they look for one of the others?

[00:31:15] David M. Aronoff: Well, we don't have a firm answer to that. And in fact, that's reflected in the guidelines from the CDC who say, you know what? You can get whatever vaccine type you want. If you want to get a J&J single dose type of vaccine for your booster, you certainly can, but it's safe to mix and match. And so you can get an mRNA vaccine. Some data suggest that the mRNA vaccines are a bit more durable than the J&J vaccine, but we don't have a lot of data yet to guide us. What I'll say is that getting whatever booster someone can get is much, much more important than not getting boosted at all. And if we could get to the point where as many people as are eligible have had their first round of vaccines, that would be a significant success and the same for getting boosters. But for sure, it's okay to mix and match.

[00:32:13] Bill Walsh: Okay, we're going to be talking more about that in just a few minutes. Let's go back to the phone lines. Jesse, who do we have on now?

[00:32:21] Jesse Salinas: I'd like to bring on Chrissy from Florida.

[00:32:24] Bill Walsh: Hey, Chrissy. Welcome to the program. Go ahead with your question.

[00:32:28] Chrissy: Good afternoon. We'll be gathering like everyone, large family and many of them, about four of them travel all over the United States, out of the country. I know of one that's not vaccinated. Am I safe to just be wearing a mask? They’re more than willing, everyone, to wear a mask, but I have wondered if it can just be, I wear my mask, and then when I’m outside with my granddaughters, that I don’t have to wear a mask. We’re all, the granddaughters both have their first vaccinations and I’m going for my booster this week.

[00:33:10] Bill Walsh: Okay, Dr. Eckardt, I wonder if you could talk about what steps Chrissy and the rest of her family should be taking when they gather for the holidays.

[00:33:18] Paula Eckardt: Well, what I will recommend to someone in my family; if you are a high-risk patient, meaning you have other medical conditions, obviously, you know, older than 65. So it puts you at higher risk for COVID, for severe COVID. If you’re going to be in close contact with people that have potentially been exposed to COVID, and they are not vaccinated with the complete series, it might put you at higher risks. So, if that's what you guys decided that that's what you guys want to do, gather together, I will say everybody should be wearing masks including the people that are not vaccinated and the people that are partially vaccinated, just so they can, in case they are infected with COVID and not having any signs or symptoms of COVID, that they don't expose you. Because the whole point of wearing the mask is to prevent the person that is sick to get those droplets out in the space and then give it to other people. So, I think that it's important to think about that. Other things you could do is have them get tested right before the gathering. I know people don't like to do that, and sometimes they can't find places to get tested. And definitely, absolutely, if someone has a symptom, they should not be in there. Again, you know, I know that it is wintertime, but you know, if you're in Florida and you can do some gathering outside, I would suggest that that will be the best option.

[00:34:55] Bill Walsh: All right, Dr. Eckardt, thanks so much for that. And thanks for all the questions from our listeners. We're going to take more of those questions soon.

[00:35:01] [Española]

[00:35:20] Let's turn back to our experts. Dr. Aronoff, for someone who was fully vaccinated six months ago, how much of the vaccine's potency has been lost and does a booster replace that waning effectiveness?

[00:35:35] David M. Aronoff: Yeah, really, really great question, Bill. So, it depends a little bit on the exact vaccine, but in general, after about six months, probably about 40 percent of the protectiveness has been lost in terms of being vulnerable to getting symptomatic COVID. However, we don't lose that much effectiveness in terms of preventing hospitalizations or death. In fact, the vaccines seem to be pretty durable in terms of keeping people out of the hospital and saving lives. But the effectiveness against just getting symptomatically ill does seem to wane about 30 to 40 percent after six months, and the whole purpose of the boosters is exactly what your question suggests. The boosters restore and even augment our defenses against getting symptomatic COVID, against getting severe disease that might put us in the hospital, and restore our strength against even dying from COVID, and importantly, the original vaccines and the boosters make us harder to infect and harder to transmit the virus. So, by getting our booster shots, we’re not only providing better protection for ourselves, but we’re making it more likely that we will not be part of the chain of transmission that ends up giving the virus to somebody who might get very sick.

[00:37:02] Bill Walsh: That’s a great point, Dr. Aronoff, and one that I don’t think is made enough about the potential of us transmitting the virus, even if we get the vaccine. So thank you for that. I’d like to turn back to Dr. Stewart right now. You know this year has been so topsy-turvy. Early this summer, it seemed like we were returning to normal, and then the delta variant set us all back. Now the threat of omicron is lurking out there. What is the impact of all of this volatility on our mental health and how detrimental is it?

[00:37:37] Altha J. Stewart: Well, you know, that’s an excellent way to describe it. Topsy- turvy, roller coaster, hills and valleys. You know, I’ve heard all kinds of permutations of the ups and downs that we’ve endured over the last couple of years with respect to COVID. And I guess it, for me as a psychiatrist, this plays out in a couple of ways. We’re all aware that we have, each of us, been affected in some way by this kind of topsy-turvy, as you described it, relationship now that we have with this virus and through the pandemic. And so, there is the possibility and the risk that some will let down their guards because that up and down, up and down, hill and valley perspective can be very wearing and exhausting. That's the other word I've heard a lot over the last year and a half — exhausting, individually and societally. And so, we have to forever and always be on guard, I think, about getting too complacent during the good times so that we aren't able to reenergize and get back into the habits of safety that we need during those times when delta or omicron or whatever other variant may appear. When those things happen, we've got to be able to gear back up to be our, at our highest level of vigilance around our own health and safety, as well as that of those around us. There is also the possibility that people kind of get into a whatever. You know, I did all of that stuff, and I came through okay with the last year and a half, and now the delta, and I've made it through that, and now omicron, and it's just going to keep happening and happening, so why bother taking any steps to be safe and protect myself and others. And we can't allow that to be the prevailing theme in our lives either. So, finding something positive, I know I've spoken on other shows about each day trying to find something positive to get you into the spirit of, I'm in control of some things, but not everything. And whether, you know, whether that's how you socialize with family and friends in a safe manner, of course, but that you reconnect with each other. What returning to work may mean for some. What heightened levels of awareness around the virus may mean for others. That there are those things that we can do something about, be in control of, and use as guides to keep us focused on what's positive in our lives. We can't control, you know, the mutations of the virus, we can't control if we'd been around someone who may in fact be infected and passed it on, but what we can control is how we generally handle ourselves during this, and that we remain vigilant to understanding that depression, anxiety, stress, all of those things have happened to each of us in some way, shape or form over the last year and a half, and that it's okay to say, today I'm not okay, and to ask for help.

[00:40:54] Bill Walsh: Great advice. Thanks so much for that, Dr. Stewart. Dr. Eckardt, you know, a few moments ago, one of our listeners was asking about the effectiveness of one of the vaccines and we started talking about mixing them. What advice can you offer about mixing vaccines? Are there any benefits to it? And of course, we're in the midst of flu season. Is there any risk of getting the COVID vaccine at the same time you get others such as flu vaccines, DTap?

[00:41:21] Paula Eckardt: I think we know more now, and we feel more comfortable mixing the vaccines that, you know, in the past we didn't have the information. So our practice now is to, you know, if you can get the original vaccine that you got, you know, good. Get that one as a booster. If you can't get it or it's not available, then you can mix it. For example, you've got the Pfizer series, then you can get a Moderna booster. And a lot of my patients have already done that, and we haven't seen any problems with that. So, I think that's important to know. Also with the flu season, at the beginning there was a recommendation to wait at least two weeks between, you know, vaccines. But right now the recommendation is to, you know, get the vaccines. You can get them at the same time. Actually myself, I got at the same time with no problems. So, I think that people should be vigilant that we are, you know, in the wintertime, and this is when we see a lot of those respiratory infections and we still can't see influenza, and influenza every year strikes a lot of people and end up in the hospital and some people ended up dying. So, I think it's important to continue to vaccinate for those and get their booster for COVID.

[00:42:43] Bill Walsh: Thanks for that, Dr. Eckardt. Now it's time to address more of your questions with Dr. Aronoff, Dr. Stewart and Dr. Eckardt. Jessie, who do we have next on the line?

[00:43:05] Jesse Salinas: Yeah, Bill, on the next one, we're going to take a question from YouTube. I've got a question from Lisa on Facebook and she's saying, "This pandemic has had her having issues staying connected to people, right, with social distancing and such, and now Medicare is not accepting her mental health therapists." Are there options to help her keep her therapist or to help her find a new one.

[00:43:25] Bill Walsh: Dr. Stewart, you seem ideally positioned to answer that question from Lisa.

[00:43:29] Altha J. Stewart: Yes. and thank you, Lisa, for that question. Unfortunately, there's no individualized answer that I can offer because these are the kinds of issues that are really regional and state and sometimes locally specific. In general, there are a couple of things that I would advise, that you work very closely with the therapist to assure that you have done all of the necessary or taken all of the necessary steps. If there is a question that it is going to be prohibited, that you've done everything along with the therapist to appeal those decisions using the justification and grounds that lead you both to believe that staying connected is in your best interest from a health care perspective. The other thing is that you and the therapist both need to explore what is available in your area in the form of support from your providers, depending on the discipline, their particular focus on advocating for care in your area. And that you are aware of what various consumer groups are also doing in support of assuring those things stay intact, those relationships stay intact. There's an awful lot of activity by providers and consumer organizations during this time of topsy-turvy, that are being seen as effective in many areas. The expansion of tele-health as a means of staying connected and those things are a direct result of providers and consumers ensuring that the message is very clear that this is an important time for there to be no breaks in those kinds of relationships. So do all of those things and I regret I don't have more specific guidance on how to do it, but that will get you started in terms of advocating for what you need and good luck.

[00:45:33] Bill Walsh: All right, Dr. Stewart. Thanks so much for that. Jesse, who's up next?

[00:45:37] Jesse Salinas: I'm going to take another one from YouTube, Bill. This is, her name is Edna, and she says, "We're terrified about the vaccine having material that might be dangerous to older people, and for that reason, I've not had, gotten my shot. Is there any truth to what I've been seeing online?"

[00:45:53] Bill Walsh: Dr. Aronoff, I wonder if you can address those concerns. We're hearing a lot of, I would say, myths out there about what's in the vaccine and what isn't. Can you set the record straight?

[00:46:05] David M. Aronoff: Sure, and I want to thank Edna for that question. And I think the question really does a good job of helping us think through the fact that people who have not yet been vaccinated often have very different concerns. And an important one that we hear over and over is questions about safety. We now know that these vaccines went through the usual clinical studies — phase 1, phase 2, and large phase 3 studies with tens of thousands of people — and did not show any unexpected safety problems. And now we've used the vaccines worldwide in about, I think we've given about 8 billion doses. In the United States, we've given almost 500 million doses; I think we're at about 470 million doses of these vaccines. And we've been able to do that under the watchful eye of every person who has received the vaccine, every person who has delivered the vaccines, and the usual oversight bodies like the FDA and the CDC. And we just, you know, we really have very, very good data to show that in older adults, these vaccines are very safe and very effective. People get sore arms. They can have fatigue and fever and feel under the weather for a few days after getting vaccinated, and we're now kind of used to the fact that those are possibilities, but that's often just our immune system responding to the vaccine. So, you know, the ingredients that are in the vaccine include the part, the business end of the vaccine that's meant to train our immune system on the COVID virus to prevent infection, and then things that are important to keep the vaccine stable until it can do its job. But these are ingredients that are used in lots of medicines, used in other vaccines, and we have a long track record with their safety. So I appreciate Edna's question. If there are rumors out there about these vaccines being dangerous for older people, that is mythology.

[00:48:10] Bill Walsh: Yeah. And Dr. Aronoff, I mean, you talked about what's in the vaccine. I think it's important to also talk about what's not in it, which is the live virus, right?

[00:48:18] David M. Aronoff: Super-important point, Bill, and I'm glad that you brought that up. These vaccines that we're using are not the live SARS-CoV-2 virus. They are really designed to train our immune system on one part of the virus, which is called the spike protein, which is a little bit like the Velcro on the outer surface of the virus that's important for the virus to set up infection in us. And so these vaccines have ingredients that help instruct our immune response against the spike protein, but they are not including any live virus at all.

[00:48:53] Bill Walsh: Okay, thanks so much for that. Jesse, who do we have next?

[00:48:58] Jesse Salinas: Yeah, our next question is going to come from Tom in Wisconsin.

[00:49:02] Bill Walsh: Hey, Tom. Welcome to the program. Go ahead with your question.

[00:49:07] Tom: Hi, my question is, I've had the three shots. I'm a high-risk person, and what is the, will I be able to pick up anything from this, from this point on? That was my question, and then one other question was, what are we doing about our, the nurses and doctors that are so overwhelmed with the work that they've got in front of them?

[00:49:37] Bill Walsh: Hmm. Those are, those are some great questions, Tom. Dr. Eckardt, you know, Tom's gotten three shots. It sounds like he's at high risk. How much does he have to worry about contracting COVID-19 at this point?

[00:49:51] Paula Eckardt: I think everybody has to look at the area where they're at right now, if there's a lot of COVID in their area, if there's an outbreak going on right now in the area. So you will be at higher risk if you are there. If you got your third shot, and you're not an immunocompromised person, meaning you're not a cancer patient or somebody that is using medications to decrease your immune system, most likely the vaccines are effective, and they will protect you from severe disease. There are, here and there, cases where even though everybody gets all the vaccines that they get, they're supposed to get, they still got the disease, and could end up in the hospital, but the possibility is less likely for those that got the booster shot. And I do want to say something about the physician burnout and what's happening with the health care epidemic of, you know, being tired of this. So, we've been battling COVID since March 7th, 2020, at my hospital, and I think that there have been so many good things that came from it, and specifically, support from, you know, the administration in the sense that we have a lot of mental health support, and we can reach out when we are tired. But nevertheless, when we have those surges, it is a little bit tough and you just have to, like Dr. Stewart was saying, like every day just think positive that, you know, one day at a time and that we are going to be fine. And I think that we now have more armamentarium to treat our patients and in the beginning we didn't. So it was very frustrating. So right now, even though we still have some patients that do complicate and end up dying, we feel more confident in the way we treat the patients and the way our system is responding to the pandemic, especially now that we have the vaccine.

[00:52:04] Bill Walsh: Thanks so much for that, Dr. Eckardt. Jesse, who do we have next on the line?

[00:52:10] Jesse Salinas: Our next call is Dale from New Mexico.

[00:52:13] Bill Walsh: Hey, Dale, welcome to our program. Go ahead with your question.

[00:52:18] Dale: My question is, does the body build up an antibody to the virus if you have a case of the virus, no matter how mild?

[00:52:29] Bill Walsh: Right. Interesting question and much discussed. Dr. Aronoff, can you talk about that and how long any protection might last.

[00:52:39] David M. Aronoff: Yeah, Dale raises a really important question. First of all, with vaccination, one of the advantages of vaccination over depending on natural sort of infection to boost our immune system is that vaccinations give us a very standard, strong, specific and safe immune response against the SARS-CoV-2 virus. The question that Dale really asks is, after an infection, what happens to our immune response? And it is clear that people who have asymptomatic COVID, which is a strikingly large number of people, may not get a strong immune response compared to someone who is severely ill or quite symptomatic. In fact, the stronger the symptoms are, generally the stronger the immune response is. And that's been now shown in many studies. And so, if somebody didn't know they had COVID, but they get a test that shows that they have COVID, in other words, they've had asymptomatic COVID, it is really hard to know what to tell them about how protected they are against getting reinfected. And it is likely that that protection would wane more quickly than if they had had a severe illness, which we would never wish on someone. Vaccination takes care of this problem by giving us the same dose that gives us a very predictable, strong immune response in a much safer way than depending on infection. So I hope that that helps with Dale's question.

[00:54:14] Bill Walsh: Yeah, thanks so much for that, Dr. Aronoff. I appreciate it. Jesse, who do we have next on the line?

[00:54:19] Jesse Salinas: We're going to bring Winona from Missouri on.

[00:54:22] Bill Walsh: Hey, Winona, welcome to our program. Go ahead with your question.

[00:54:26] Winona: Thank you for taking my question. Last week my granddaughter tested positive for the COVID-19, and I was, you know, staying at her house. So, I went last Friday and had the test, and they said that I didn't, that I was negative. But after that I've gotten ill, and I'm just kind of getting over it. I did, I had a temperature a couple of times. I didn't have any headaches. I had a cough and I still kind of got a cough now. So, I was planning on going to have a test again today. So I just wondered, is it too close to have the test again today? Or is it all right to go? And what about I have, I've had my two shots and I've also had the flu shot.

[00:55:29] Bill Walsh: Okay. And when did you say you had your last COVID test, Winona?

[00:55:33] Winona: I had it last Friday.

[00:55:35] Bill Walsh: Got it. Okay. Let's ask one of our experts. Dr. Eckert, what do you suggest for Winona?

[00:55:40] Paula Eckardt: Well, with the delta variant we were always suggesting to test three to five days after the exposure. So, I think that if she just got tested last Friday and the exposure was before that she could definitely get tested right now. I think it's actually very important for her to get tested to make sure with the symptoms that she's telling us, that she's, you know, doesn't have COVID, so she can either get monoclonal antibodies or get another evaluation. Also, she needs to make sure that she's not infected. And I think she was asking about also when she can get the booster. So, if she is infected right now, she will need to wait until she's no longer infectious. So, usually it's around 10 days after the first symptoms started, depending on the severity of disease, but it's usually 10 days. And then after that she could potentially get her booster. If she gets monoclonal antibodies for, you know, because she has a mild disease and her doctor recommends that, then the delay on the vaccine might be for 90 days. But definitely need to contact your health care provider and decide on getting a test as soon as possible.

[00:56:57] Bill Walsh: Okay, Dr. Eckardt, thank you so much for that. And thanks to all of our experts for being with us. Today has been a really informative discussion. I'm going to also thank you, our AARP members, volunteers and listeners, for participating in the discussion today. AARP, a nonprofit, nonpartisan membership organization, has been working to promote the health and well-being of older Americans for more than 60 years. 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, December 10th. Again, that address is aarp.org/coronavirus. 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 next week, December 16th, at 7 p.m. Eastern Time for a special Tele-Town Hall featuring Dr. Francis Collins, the director of the National Institutes of Health. He will give us the latest on the virus and the vaccines and take your questions live. We hope you can join us. Thank you and have a good day. This concludes our call.

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

[En español]

Bill Walsh: AARP, una organización de membresía sin fines de lucro ni afiliación política, ha estado trabajando para promover la salud y el bienestar de los adultos mayores de Estados Unidos durante más de 60 años. Frente a la pandemia mundial de coronavirus, AARP está proporcionando información y recursos para ayudar a los adultos mayores y a quienes los cuidan.

Parecía que hace apenas un mes las cosas estaban comenzando a volver a la normalidad, pero la aparición de la variante ómicron ha reavivado las preocupaciones de muchas personas en el país mientras se preparan para reunirse durante los días festivos. El aumento en las tasas de vacunación contra COVID-19 nos reconforta.

Sabemos que la protección de la vacuna disminuye con el tiempo, y unos 100 millones de personas en EE.UU. que pueden recibir las vacunas de refuerzo aún no las han recibido. Mientras tanto, en el frente político, el Congreso podría estar a punto de aprobar una legislación histórica que finalmente podría reducir los costos de los medicamentos recetados en el país.

Hoy escucharemos a un impresionante panel de expertos hablar sobre estos temas y otros. Y la semana que viene, organizaremos un evento especial con el Dr. Francis Collins, Director de los Institutos Nacionales de Salud. Si han participado en alguna de nuestras teleasambleas antes, 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 nos acompañan por teléfono, si desean hacer una pregunta sobre la pandemia de coronavirus, marquen * 3 en su teléfono. Así se conectarán con un miembro del personal de AARP que anotará su nombre y su pregunta y los colocará en una lista 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 principales expertos y respondiendo sus preguntas en vivo. Para hacer una pregunta, presionen * 3. Y si se unen a través de Facebook o YouTube, dejen su pregunta en la sección de comentarios.

Tenemos unos invitados excepcionales que nos acompañarán hoy, incluidos dos expertos en enfermedades infecciosas y una experta en salud mental. También nos acompañará mi colega de AARP, Jesse Salinas, quien ayudará a facilitar sus llamadas hoy. Este evento está siendo grabado y podrán acceder a la grabación en AARP.org/coronavirus 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. O si se unen a través de Facebook o YouTube, dejen su pregunta en los comentarios.

Ahora me gustaría dar la bienvenida a nuestros invitados. El doctor David M. Aronoff es director de la División de Enfermedades Infecciosas en la Facultad de Medicina del Centro Médico de Vanderbilt University. Bienvenido de nuevo al programa, Dr. Aronoff.

David M. Aronoff: Me complace estar aquí. Gracias por recibirme.

Bill Walsh: Estamos encantados de tenerlo de vuelta. La doctora Altha J. Stewart es decana adjunta principal para Compromisos de Salud Comunitaria, y profesora adjunta y directora de la División de Psiquiatría Social y Comunitaria de University of Tennessee Health Science Center. Bienvenida de nuevo al programa, Dra. Stewart.

Altha J. Stewart: Gracias, Bill. Es un placer volver a estar aquí.

Bill Walsh: Y la doctora Paula Eckardt es la directora de la División de Enfermedades Infecciosas del Memorial Healthcare System. Bienvenida al programa Dra. Eckardt.

Paula Eckardt: Gracias por invitarme.

Bill Walsh: Gracias a todos por estar aquí. Comencemos con la discusión. Y como recordatorio para nuestros oyentes, para hacer una pregunta, por favor presionen * 3 en el teclado de su teléfono o escriban en la sección de comentarios en Facebook o YouTube. Comencemos.

Dr. Aronoff, al principio hubo algunas restricciones sobre quién podía recibir los refuerzos contra la COVID-19. Pero ahora esto se ha ampliado. ¿Puede hablarnos de quién puede recibirlos? ¿Y por qué la dosis de refuerzo se ha convertido en una prioridad? Y quizás también podría abordar qué tan efectivas son las vacunas contra ómicron.

David M. Aronoff: Seguro. Bueno, de nuevo, Bill, gracias por invitarme. Y es un honor estar con estas invitadas. Sabe, tiene toda la razón. Nos estábamos manejando un poco por etapas con el modo de usar los refuerzos, pero ahora se recomiendan para cualquier persona mayor de 18 años que ya haya completado la primera ronda de vacunación.

Si las personas recibieron las vacunas de ARNm que ofrecen Pfizer o Moderna, entonces deben esperar al menos seis meses, y luego pueden recibir el refuerzo y si recibieron la vacuna de dosis única de J&J, luego de que hayan pasado dos meses desde la vacunación, pueden recibir los refuerzos.

Sabe, ciertamente hemos visto que las vacunas pueden disminuir con el tiempo, en el sentido de volver a ser vulnerables a contraer COVID-19. Y estamos viendo el surgimiento de esta variante que se conoce con el nombre de ómicron, que parece ser bastante contagiosa. Y queremos asegurarnos de tener las mejores defensas contra esta variante para mantenernos fuera del hospital y asegurarnos de que la menor cantidad posible de personas se enfermen. Por eso, insistimos en que ahora es el momento, si responden al criterio, para recibir ese refuerzo.

Bill Walsh: ¿Y tenemos alguna información sobre la eficacia de las vacunas contra ómicron? Sé que todavía es temprano en ese sentido.

David M. Aronoff: Sí, ha habido datos de dos fuentes diferentes. Una es en el laboratorio, en una placa de Petri básicamente, donde podemos tomar muestras de sangre de las personas después de que hayan sido vacunadas y ver si los anticuerpos de su sangre pueden bloquear el virus, en este caso la variante ómicron, para que no infecte las células humanas en una placa de Petri.

Y hay datos que sugieren que después de la vacunación inicial, nuestros anticuerpos no bloquean tan bien el virus ómicron en una placa de Petri en comparación con el bloqueo de la variante delta o la variante original. Sin embargo, recientemente supimos que después de una dosis de refuerzo de la vacuna de Pfizer, esos niveles de anticuerpos en la sangre son lo suficientemente altos como para que, al menos en una placa de Petri en el laboratorio, bloqueen eficazmente al virus ómicron y eviten que cause una infección.

Lo que realmente no sabemos es el efecto de estas vacunas en el mundo real contra la variante ómicron. Hay algunas sugerencias de que las personas que están vacunadas están protegidas contra una enfermedad grave, pero aún es muy, muy temprano y creo que hay mucho más que debemos averiguar, pero incluso nos enteramos muy recientemente de que la FDA ha aprobado dar una dosis de refuerzo de Pfizer a jóvenes de 16 y 17 años. Y creo que la urgencia aquí es que realmente queremos asegurarnos de que, a medida que ómicron se propague, obtengamos el mayor beneficio posible de las vacunas disponibles.

Bill Walsh: Bueno, déjeme seguir con eso, Dr. Aronoff, quiero decir, dada la eficacia de las vacunas y la protección contra la COVID-19 o al menos al minimizar su gravedad, ¿por qué cree que no hemos visto una adopción más rápida a las dosis de refuerzo? Quiero decir, ¿cuál es el mensaje que necesitan escuchar los 100 millones de personas que pueden recibir un refuerzo?

David M. Aronoff: Bueno, ciertamente la gente va a recibir refuerzos, lo cual es fantástico. Y ciertamente recomendaría a cualquiera que esté escuchando hoy, que si es apto para ello, busque los refuerzos, son gratis y están fácilmente disponibles. Ya sabe, hay muchos factores para comprender por qué la gente aún no ha salido a recibir su refuerzo.

Parte de ello es no saber dónde conseguir los refuerzos. Hay dudas sobre si la gente cumple con los requisitos o está disponible para recibir las vacunas de refuerzo. Y luego, por supuesto, está el cansancio en torno a la cuestión de, caramba, ya me he vacunado dos veces, o ya me he vacunado.

La vacunas parecen surtir efecto, ¿realmente necesito recibir esta otra vacuna? La gente se está vacunando contra la gripe".

Y pueden pensar, ya sabe, "voy a esperar y ver". Pero, como se mencionó anteriormente, estas vacunas no solo son efectivas para prevenir las complicaciones de la COVID-19, sino que también son muy, muy seguras. Y eso puede ser motivo de preocupación. Alguien dice: "Recibí mis vacunas iniciales, ¿qué pasa si cuando recibo mi refuerzo tengo una mala reacción?"

Y lo que los datos nos demuestran claramente es que las dosis de refuerzo no causan peores reacciones que las dosis iniciales, pero debemos ser realmente buenos para transmitir ese mensaje.

Bill Walsh: Bien, gracias, Dr. Aronoff. Dra. Eckardt, vayamos a usted y hablemos de estas variantes. Siento que todos estamos aprendiendo el alfabeto griego por las peores razones. Pero, por supuesto, como sabemos, el virus de la COVID-19 continúa mutando, razón por la cual hemos visto variantes como delta y ómicron y quizás otras. ¿Continuará esa mutación indefinidamente? ¿Y es probable que haya más refuerzos? Me pregunto si, en última instancia, se convertirán en algo tan rutinario como una vacuna contra la gripe.

Paula Eckardt: Bueno, una de las posibilidades es que siga mutando y causando una enfermedad lo suficientemente grave como para que se nos exija una vacunación constante, como hacemos con las vacunas de la gripe, como cada año más, más probable. También puede suceder lo contrario.

También podría suceder que las mutaciones también podrían hacer que el virus sea menos efectivo y cause quizás una enfermedad no tan grave o una enfermedad leve, pero tenemos que esperar a que eso suceda para saber exactamente con qué nos encontraremos a largo plazo.

Pero por ahora, estoy de acuerdo con todo lo que dijo David, y creo que la gente solo tiene que pensar en recibir su dosis de refuerzo o su tercera dosis lo antes posible porque todavía estamos aprendiendo sobre estas nuevas variantes, específicamente, la que viene después de delta. Y esperamos que no sea tan grave como la variante delta, pero aún no sabemos mucho al respecto.

Bill Walsh: Bien, gracias, Dra. Eckardt por su respuesta. Dra. Stewart, vamos a traerla a la conversación. Este otoño, los CDC actualizaron su lista de enfermedades subyacentes que ponen a las personas en mayor riesgo de contraer COVID-19 grave. Agregaron los trastornos del estado de ánimo a esa lista. Y esta no es una pequeña cantidad de personas, al menos 34 millones de personas en el país, es decir, 1 de cada 10, padece trastornos del estado de ánimo.

Entonces, ¿por qué las personas con problemas de salud mental, incluso los trastornos del estado de ánimo comunes, como la depresión o la ansiedad, tienen un mayor riesgo de contraer COVID-19? ¿Y qué se puede hacer al respecto?

Altha J. Stewart: Bueno, Bill, primero, gracias a AARP por traer la salud mental y las enfermedades mentales a esta discusión. A menudo, esas son las áreas que no se discuten cuando hablamos de lo que la mayoría de la gente considera que es un problema médico general. Y parte de la respuesta a su pregunta tiene que ver con el estigma general que persiste en torno a la salud mental y las enfermedades mentales.

Algunos estudios sugieren que las personas que padecen enfermedades mentales tienen más probabilidades de tener una vida de hasta 25 años más corta que quienes no padecen enfermedades mentales. Así pues, ante algo como el coronavirus y la pandemia y estas variaciones que estamos observando, resulta imperativo que las personas que ya corren el riesgo de tener menos contactos con el sistema de salud general para la atención médica general, ya sea la hipertensión o la diabetes o enfermedades más graves como varios tipos de cáncer y enfermedades renales y demás, sean más susceptibles, si contraen el virus, de sufrir algunos de los peores resultados debido a su mal estado de salud al tener el virus.

Entonces, cuando pensamos en personas con enfermedades mentales y, en particular, trastornos del estado de ánimo, ya sabe, si pensamos en alguien que está deprimido, es menos probable que quiera interactuar, es menos probable que quiera hacer un seguimiento, es menos probable que quiera salir y participar, y es más probable que diga que lo que sea que esté sintiendo probablemente esté relacionado con su depresión, en lugar de tratarse de primeros síntomas de algo como la COVID-19. Por eso debemos prestar especial atención.

Y creo que el campo de la salud mental, en general, está comenzando a darse cuenta del hecho de que si nuestros pacientes tienen menos probabilidades de recibir atención médica general, entonces realmente debemos ser asertivos y asegurarnos de que en un momento como este, en el medio de esta pandemia, que estemos enfocando suficiente atención en asegurarnos de que tengan la información y el acceso para obtener lo que necesitan, ya sea la vacuna inicial o el refuerzo.

Bill Walsh: Bien, muchas gracias, Dra. Stewart. Ahora tengo una pregunta para todos ustedes, una pregunta rápida, este es un momento confuso, los estados y las comunidades tienen diferentes reglas para el uso de mascarillas y el distanciamiento social, y con los negocios sucede lo mismo. Y, por supuesto, es imposible saber si alguien que conoces está vacunado o no.

Entonces, ¿cómo llevan a cabo las personas sus actividades diarias, incluso si están completamente vacunadas? ¿Hay algunas reglas generales que debamos seguir para salir a cenar, ir al teatro o disfrutar de la familia de forma segura durante las vacaciones? Dr. Aronoff, ¿tiene alguna respuesta para eso?

David M. Aronoff: Bueno, es una gran pregunta. Y creo que, independientemente de las normas o políticas locales a las que estos virus del SARS-CoV-2 no pueden prestar atención o leer, debemos recordar que los fundamentos de cómo reducimos el riesgo de contraer o propagar la COVID-19 son exactamente los mismos hoy que hace un mes o hace un año. Y eso significa evitar los espacios interiores abarrotados a menos que sea absolutamente necesario estar en ellos.

Y si estamos en espacios cerrados con otras personas con las que no convivimos, deberíamos usar una mascarilla. No deberíamos salir si no nos sentimos bien, y deberíamos asegurarnos de que estamos vacunados, y durante esta época del año, eso significa no solo asegurarnos de que estamos vacunados o reforzados contra la COVID-19, sino también que tenemos nuestra vacuna contra la gripe.

Bill Walsh: Está bien, Dra. Stewart, ¿quisiera agregar algo a eso?

Altha J. Stewart: Sí, hemos desarrollado tres cosas básicas. Alentamos a las personas a que se mantengan informadas a medida que surja nueva información sobre las cosas, que integren eso en su forma de comportarse y pensar sobre cómo les va individualmente, cómo están lidiando con el riesgo del virus. Y que, como dijo el Dr. Aronoff, se trata de hacer que uno se sienta cómodo, así que si quiere salir y no está seguro de los demás, asegúrese de usar algún tipo de cubierta facial y siga las pautas generales de salud pública sobre el distanciamiento social y el lavado de manos.

Y finalmente, dado que esto es psicológicamente tan importante en su contribución a la aparición de la ansiedad y el estrés en torno a estas cosas, recuerde siempre que está bien hacer lo que le hace sentir cómodo, incluso si es con la familia que está, ya sabe, indecisa sobre si vacunarse o no, se trata de que usted se sienta cómodo cerca de ellos.

Bill Walsh: Está bien. ¿Y Dra. Eckardt?

Paula Eckardt: Yo diría que estoy de acuerdo con todos los demás panelistas, pero creo que debemos tener en cuenta que muchas personas viven en hogares multigeneracionales y tenemos personas de diferentes edades en el mismo hogar. Y puede que tenga diferentes situaciones de vacunación de esas personas y que estén cuidando a las personas más vulnerables de la casa.

Si son adultos mayores, las personas que tienen todas las comorbilidades como diabetes, EPOC, cosas así. Y, por ejemplo, hay una persona más joven en la casa que podría estar vacunada o no, que trae amigos dentro de la casa y no conocemos el estado de esas personas con respecto a la vacunación, creo que es entonces cuando tenemos que tener mucho cuidado con el resto de nuestros familiares cuando no sabemos quién está vacunado o no, y evitar, básicamente, los espacios interiores abarrotados, pero también situaciones como la que acabo contar.

Bill Walsh: Está bien. Gracias a todos nuestros expertos, y no podrían llegar en un mejor momento cuando las familias se reúnen para las vacaciones. Como recordatorio a nuestros oyentes, para hacer una pregunta, presionen * 3 en el teclado de su teléfono. Y llegaremos a esas preguntas en vivo en solo un momento. Pero antes de hacerlo, quiero traer a Nancy LeaMond. Nancy es la vicepresidenta ejecutiva y directora de Activismo y Compromiso de AARP. Bienvenida, Nancy.

Nancy LeaMond: Encantada de estar aquí, Bill. Gracias por invitarme.

Bill Walsh: Gracias por estar aquí. Sabemos que ha sido un momento de mucho trabajo en el Congreso y lo seguirá siendo, especialmente en lo que se refiere a la legislación que afecta a los adultos mayores de Estados Unidos. ¿Cuáles son las últimas novedades?

Nancy LeaMond: Bueno, el Senado volvió a reunirse esta semana y estamos vigilando de cerca lo que sucederá con la ley Build Back Better. Este es el proyecto de ley que aprobó la Cámara el mes pasado e incluye una medida histórica para reducir los precios de los medicamentos recetados. AARP ha estado luchando con uñas y dientes para poner fin a los precios injustos de los medicamentos, y estamos a punto de ver que el Congreso finalmente toma medidas. En este momento, estamos trabajando arduamente para asegurarnos de que las disposiciones sobre el precio de los medicamentos se mantengan en el proyecto de ley y lo apruebe el Senado.

Bill Walsh: Bien, entonces, ¿cómo ayudarían estas nuevas disposiciones a reducir los costos de los medicamentos para los adultos mayores del país?

Nancy LeaMond: Las personas en el país a menudo pagan de dos a tres veces más por los mismos medicamentos recetados que los habitantes de otros países desarrollados. Y es hora de poner fin a eso. El proyecto de ley aprobado por la Cámara de Representantes que ahora está frente al Senado incluye reformas significativas para reducir los costos de los medicamentos; finalmente, a Medicare se le permitiría negociar algunos precios de los medicamentos.

No puedo enfatizar lo suficiente lo importante que es eso. Además, las compañías farmacéuticas serían penalizadas si aumentan sus precios más rápido que la tasa de inflación. Y habría un nuevo límite anual en lo que las personas mayores que están inscritas en la Parte D de Medicare pagan de su bolsillo por sus recetas, así como un límite mensual en los copagos de insulina.

Ahora es posible que hayan visto anuncios de compañías farmacéuticas que afirman que esto limitaría el acceso a los medicamentos recetados o que es una fijación de precios por parte del Gobierno. Eso es una tontería. Estas son tácticas atemorizantes de las grandes farmacéuticas, que se han beneficiado durante años al cobrar de más a los consumidores del país. No crean eso. La reducción de los precios de los medicamentos recetados hará que los medicamentos sean más asequibles y ayudarán a todas las personas del país.

Bill Walsh: Muy bien. Gracias por esa actualización. Ahora, además del Gobierno federal, gran parte de la defensa de AARP ocurre también a nivel estatal y local, ¿cuáles son algunas de las prioridades que AARP asume a nivel estatal?

Nancy LeaMond: Bueno, como dijo, AARP tiene oficinas en todos los estados y dedicamos mucho tiempo y esfuerzo a luchar por un cambio positivo en las capitales de los estados y las comunidades de todo el país. Actualmente abogamos por políticas que protejan y promuevan la salud y la seguridad financiera de los adultos mayores del país, como la ampliación del acceso a los planes de ahorro para la jubilación, la atención médica asequible y la reducción de las tarifas de los servicios públicos. También luchamos por un transporte y una vivienda seguros y accesibles, así como por un acceso a internet de alta velocidad para ayudar a las personas a mantenerse conectadas.

Bill Walsh: Muy bien. Ahora, Nancy, una de las dimensiones menos discutidas de la pandemia de COVID-19 ha sido el escenario donde ha tenido el mayor impacto. Aproximadamente 86,000 residentes y personal de hogares de ancianos han muerto a causa del virus y eso es casi una cuarta parte de todas las muertes por COVID-19 en EE.UU. ¿Qué se puede hacer para detener esto?

Nancy LeaMond: Lo que sucedió en los hogares de ancianos es una vergüenza nacional y AARP ha estado liderando la carga para abordarlo. Seguimos instando a los funcionarios electos a nivel federal y estatal a tomar medidas y asegurarse de que no veamos una repetición de muertes innecesarias. Debemos asegurarnos de que los fondos públicos proporcionados a los hogares de ancianos se utilicen para vacunas, pruebas, personal adecuado y para mejorar la salud y la seguridad de los residentes.

La pandemia sacó a la luz problemas que han afectado a los hogares de ancianos durante décadas, incluida la escasez de personal, el control deficiente de infecciones, la transparencia y la rendición de cuentas. AARP continuará arrojando luz sobre lo que está sucediendo en los hogares de ancianos y presionará muy, muy duro para que se realicen reformas a largo plazo.

Bill Walsh: Bien, Nancy, gracias por esas actualizaciones. Y muchas gracias por estar aquí hoy.

Nancy LeaMond: Bueno, gracias por invitarme.

Bill Walsh: Está bien. Ahora es el momento de abordar sus preguntas sobre el coronavirus con el Dr. Aronoff, la Dra. Stewart y la Dra. Eckardt. Y como recordatorio, presionen * 3 en cualquier momento en el teclado de su teléfono para conectarse con un miembro del personal de AARP para compartir su pregunta en vivo. Y 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, Jesse Salinas, para ayudar a facilitar sus llamadas hoy. Bienvenido, Jesse.

Jesse Salinas: Es un placer estar aquí, Bill.

Bill Walsh: Muy bien, gracias. ¿A quién tenemos primero en la línea?

Jesse Salinas: Nuestra primera llamada de hoy será de Cory en Illinois.

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

Cory: Hola. Al ver que hay tanta gente de AARP que escucha, me encantaría hacer una pregunta sobre por qué AARP tiende a empujar a las personas mayores hacia los programas Medicare Advantage que probablemente no son apropiados, pero este no es realmente el lugar para eso. Mi pregunta para este lugar es que, desde el principio, ha habido muchos datos sobre la vacuna Pfizer. Y entiendo que Pfizer y Moderna son vacunas de ARNm, pero no parece que recibamos muchos datos sobre la eficacia de la vacuna Moderna. Y me pregunto si la razón es solo que es una empresa más pequeña y están haciendo menos estudios o si hay algo más que lo esté causando.

Bill Walsh: Bueno, preguntémosle a uno de nuestros expertos. Dr. Aronoff, ¿quiere responder?

David M. Aronoff: Sí, Cory, gracias por su pregunta. Creo que ese es un punto muy importante. En primer lugar, Pfizer en general ha estado un poco por delante de Moderna en términos de comenzar y completar estudios, presentar sus datos a la FDA y presentar sus datos al Comité Asesor sobre Prácticas de Inmunización, o ACIP y salir, en términos de recomendaciones para uso público justo antes de Moderna, pero, de hecho, ahora tenemos muchos datos sobre la seguridad y la eficacia de ambas vacunas de ARNm. Y claramente, ambos están haciendo mucho trabajo pesado, están trabajando muy, muy bien.

Y sabemos que el refuerzo con cualquiera de esas vacunas también es realmente muy seguro y eficaz. Pero, ya sabe, recuerde también que la demora entre la primera dosis y la segunda dosis de Pfizer es de tres semanas, la demora que se usó para la Moderna fue de cuatro semanas, por lo que automáticamente se utilizó una semana adicional antes de que la gente pudiera estar completamente vacunada con Moderna y eso contribuyó a algunos de los retrasos anteriores y a obtener datos de Moderna sobre Pfizer, pero en este momento nos sentimos realmente cómodos al recomendar ambas.

Bill Walsh: Muchas gracias, Dr. Aronoff. Jesse, tomemos otra llamada.

Jesse Salinas: Nuestra próxima llamada será de Barbara en Utah.

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

Barbara: Bien, mi pregunta es que tengo una nieta que trabaja en una tienda, una tienda grande y es cajera. Su esposo y su hijo tienen COVID-19. Y sin embargo, como todavía no tiene síntomas, la obligan a ir a trabajar. Y podría quedarse en casa si quisiera, pero eso sería sin paga. Y ella es el sostén de la casa porque su esposo tuvo un terrible accidente de motocicleta. Así que no tiene más remedio que ir a trabajar. Y luego llega a casa y se ocupa de dos personas muy enfermas. ¿No creen que debería haber algún tipo de cobertura que le permitiera quedarse en casa, cuidarlos y seguir recibiendo el pago?

Bill Walsh: Sabe, esa es una buena pregunta. Y se habla mucho sobre la licencia paga en la legislación pendiente en el Congreso, de la que habló Nancy LeaMond. Me pregunto si alguno de nuestros expertos podría abordar eso. Dra. Stewart, ¿tiene alguna idea sobre eso?

Altha J. Stewart: Bueno, nada específico sobre el tema de cómo hacer que se quede en casa y que le paguen. Creo que eso está probablemente más al alcance de Nancy en términos de política, esperemos que de política pendiente, para apoyar algunas de estas cuestiones ahora que llevamos casi dos años. Diría que estoy segura de que ella tiene grandes preocupaciones sobre su propia posibilidad de contraer el virus, sino también del estrés de ser cuidadora.

Y como sabemos, AARP tiene una experiencia significativa en el apoyo de los cuidadores, y su nieta parece ser alguien que se beneficiaría de tener una red de apoyo a su alrededor. Y que ciertamente es parte de eso por el hecho de que usted hizo la pregunta. Pero también, que alentarla a no sentir que está sola en esto y ser capaz de pedir ayuda para brindar todo el cuidado que debe brindar, ciertamente ayudará a apoyarla. Y tal vez, con el tiempo, veamos algún movimiento en esa área de licencia pagada para los cuidadores de pacientes con COVID-19.

Bill Walsh: Y, Dra. Eckardt, me pregunto si también pudiera opinar sobre esto. Quiero decir, he estado leyendo mucho sobre avances y tratamientos para personas a las que se les ha diagnosticado COVID-19. ¿Dónde estamos con eso? ¿Y eso ofrecería algún alivio, consuelo para la hija y el yerno de Barbara?

Paula Eckardt: Bueno, depende de la edad y los factores de riesgo que se tenga, como, obviamente, podrían administrar anticuerpos monoclonales, para la prevención. Pero la cosa es que obviamente ella ha estado expuesta, y cada vez que regresa a casa, vuelve a estar expuesta. Por lo tanto, ella tiene un riesgo muy alto de contraer COVID-19, así que básicamente debería hacerse, ya lo sabe, espero que ya se haya hecho la prueba.

Y la recomendación es que ella no esté en contacto cercano con las personas enfermas. Habiendo dicho eso, si ella no puede hacer eso, y luego no sé sobre la situación laboral, pero si no puede hacer eso, cuando esté en contacto con ellos, definitivamente debería usar una mascarilla, y las personas que están enfermas deben usar una mascarilla y estar aisladas en áreas específicas de su casa donde ella no esté en estrecho contacto con ellos.

Las personas enfermas deberían usar su propio baño. Esa será como la recomendación principal, obviamente, si ella tiene que cuidarlos, entonces tiene que cuidarlos, pero siempre recomendaremos una especie de cuarentena, si ella no tiene que cuidarlos, debe estar lejos de ellos para que no se infecte e infecte a otras personas.

Bill Walsh: Está bien, gracias. Gracias a los dos. Tomemos otra pregunta. Jesse.

Jesse Salinas: Sí, vamos a probar con Clovis en Illinois.

Bill Walsh: Hola, Clovis. Bienvenido al programa. Continúe con su pregunta.

Clovis: Sí. La pregunta es, mi esposa y yo tenemos vacunas de Johnson & Johnson. Y no escuchamos nada al respecto. Escuchamos mucho sobre Moderna y Pfizer. Y no escuchamos nada sobre lo buena que es Johnson & Johnson. ¿Es buena o no es buena o qué? Escuchamos mucho sobre Pfizer y Moderna.

Bill Walsh: De acuerdo. ¿Ha recibido también el refuerzo o solo la dosis inicial?

Jesse Salinas: Oh, creo que lo bloqueamos, Bill.

Bill Walsh: Está bien. Dr. Aronoff, me pregunto si pudiera abordar la eficacia de la vacuna Johnson & Johnson.

David M. Aronoff: Sí, realmente aprecio la pregunta de Clovis porque hay más datos y más prensa en torno a las vacunas de ARNm. Y la vacuna de una sola dosis de J&J parece estar perdiendo fuerza un poco más rápido que las vacunas de dos dosis de ARNm, y de hecho, eso se ha traducido en diferentes recomendaciones sobre cuándo recibir vacunas de refuerzo.

Si las personas se han vacunado inicialmente con la vacuna de ARNm que sería Pfizer o Moderna, deben esperar al menos seis meses antes de recibir su refuerzo. Pero si alguien recibió la vacuna J&J de dosis única, para tratar de asegurarse de que la respuesta inmunitaria sea lo más duradera y protectora posible, la recomendación es que reciba un refuerzo a partir de dos meses después de la vacuna de dosis única.

Después de que reciben esa vacuna de refuerzo, no tenemos muchos datos, pero los datos que tenemos sugieren que es bastante protectora. La cuestión de cuánto tiempo durará esa protección aún está por determinarse. Todavía no tenemos muchos datos sobre la protección de la vacuna J&J contra la nueva variante de ómicron. Entonces, hay algunas preguntas que aún deben responderse, pero una pregunta muy, muy buena de Clovis. Y espero que esa respuesta ayude un poco.

Bill Walsh: Bueno, solo un breve seguimiento. Quiero decir, Clovis y su esposa y otros que recibieron la vacuna J&J, ¿deberían recibir el refuerzo de J&J o deberían buscar una de las otras?

David M. Aronoff: Bueno, no tenemos una respuesta firme a eso. Y, de hecho, eso se refleja en las pautas de los CDC, que dicen que uno puede recibir el tipo de vacuna que desee. Si uno desea recibir un tipo de vacuna de dosis única de J&J para su refuerzo, ciertamente puede, pero es seguro mezclar y combinar. Y así puede recibir una vacuna de ARNm.

Algunos datos sugieren que las vacunas de ARNm son un poco más duraderas que la vacuna de J&J, pero todavía no tenemos muchos datos para guiarnos. Lo que diré es que conseguir cualquier refuerzo que alguien pueda conseguir es mucho, mucho más importante que no conseguir ninguno. Y si pudiéramos llegar al punto en el que muchas personas que responden al criterio han recibido su primera ronda de vacunas, sería un éxito significativo. Y lo mismo a la hora de recibir refuerzos, pero seguro, está bien mezclar y combinar.

Bill Walsh: Bien, hablaremos más sobre eso en solo unos minutos. Volvamos a la línea telefónica. Jesse, ¿a quién tenemos ahora?

Jesse Salinas: Bien, me gustaría traer a Chrissie de Florida.

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

Chrissie: Buenas tardes. Nos reuniremos como toda gran familia. Y muchos de ellos, aproximadamente cuatro de ellos, viajan por todo Estados Unidos y fuera del país. Sé de uno que no está vacunado, ¿estoy a salvo si solo llevo una mascarilla? Están más que dispuestos a que todos usen mascarilla, pero me he preguntado si es posible que solo yo use mi mascarilla. Y luego, cuando este afuera con mis nietas, no tengo que usarla.

Bill Walsh: Está bien.

Chrissie: Ambas nietas tienen sus primeras vacunas. Y yo recibiré mi refuerzo esta semana.

Bill Walsh: Está bien, Dra. Eckardt, me pregunto si podría hablar sobre los pasos que deberían seguir Chrissie y el resto de su familia cuando se reúnan para las fiestas.

Paula Eckardt: Bueno, recomendaré lo que recomendaría a alguien de mi familia si fuese un paciente de alto riesgo, lo que significa que tiene trastornos médicos, obviamente, mayor de 65 años. Así que se pone en mayor riesgo de contraer COVID-19 grave. Si va a estar en contacto cercano con personas que potencialmente han estado expuestas a la COVID-19 y no están vacunadas con la serie completa, podrían ponerla en mayor riesgo.

Así que, si eso es lo que han decidido que es lo que quieren hacer, reunirse, diré que todo el mundo debería llevar mascarilla, incluidas las personas que no están vacunadas y las que están parcialmente vacunadas, para que, en caso de que estén infectadas con COVID-19 y no tengan ningún signo o síntoma de la enfermedad, que no se expongan. Porque el objetivo de usar mascarilla es evitar que la persona expulse las gotas en el aire y luego se las pase a otras personas. Así que creo que es importante pensar en eso.

Otras cosas que podrían hacer es pedir que se hagan la prueba justo antes de la reunión. Sé que a la gente no le gusta hacer eso. Y a veces no pueden encontrar lugares para hacerse la prueba. Y definitivamente, absolutamente, si alguien tiene un síntoma, no debería estar allí. Una vez más, sé que es invierno, pero si está en Florida y puede reunirse al aire libre, supongo que esa será la mejor opción.

Bill Walsh: Muy bien, Dra. Eckardt, muchas gracias por eso y gracias por todas las preguntas de nuestros oyentes. Pronto responderemos otras. Y recuerden, si desean hacer una pregunta, presionen * 3 en el teclado de su teléfono. Si desean escuchar este programa en español, presionen * 0 en el teclado de su teléfono ahora.

[En español]

Bill Walsh: Volvamos a nuestros expertos. Dr. Aronoff, para alguien que está completamente vacunado hace seis meses, ¿cuánta potencia de la vacuna se ha perdido? ¿Y un refuerzo reemplaza esa eficacia menguante?

David M. Aronoff: Sí, muy, muy buena pregunta, Bill. Depende un poco de la vacuna exacta, pero en general, después de unos seis meses, probablemente se haya perdido alrededor del 40% de la protección en términos de ser vulnerable a contraer COVID-19 sintomático. Sin embargo, no perdemos tanta eficacia en términos de prevención de hospitalización o muerte.

De hecho, las vacunas parecen ser bastante duraderas en términos de mantener a las personas fuera del hospital y salvar vidas, pero la eficacia contra el simple hecho de enfermarse sintomáticamente parece disminuir entre un 30% y un 40% después de 6 meses. Y el propósito de los refuerzos es exactamente lo que sugiere su pregunta.

Los refuerzos restauran e incluso aumentan nuestras defensas contra la COVID-19 sintomática, contra la enfermedad grave que podría llevarnos al hospital, y restauran nuestra fuerza incluso contra la muerte por COVID-19. Y lo que es más importante, las vacunas originales y los refuerzos hacen que sea más difícil infectarnos y transmitir el virus.

Entonces, al recibir la dosis de refuerzo, no solo nos brindamos una mejor protección, sino que también aumentamos las probabilidades de que no seamos parte de la cadena de transmisión que termina contagiando el virus a alguien que podría enfermarse gravemente.

Bill Walsh: Ese es un gran punto, Dr. Aronoff, y no creo que esté suficientemente explicada la posibilidad de que transmitamos el virus incluso si nos ponemos las vacunas. Así que gracias por eso. Me gustaría volver a la Dra. Stewart ahora. Este año ha sido tan revuelto, a principios de este verano, parecía que estábamos volviendo a la normalidad. Y luego la variante delta nos hizo retroceder a todos, ahora acecha la amenaza de ómicron. ¿Cuál es el impacto de toda esta volatilidad en nuestra salud mental y qué tan perjudicial es?

Altha J. Stewart: Bueno, esa es una manera excelente de describirlo, una montaña rusa al revés, colinas y valles, he escuchado todo tipo de situaciones de los altibajos que hemos soportado en los últimos años con respecto a la COVID-19. Y supongo que, para mí, como psiquiatra, esto se desarrolla de un par de maneras. Todos somos conscientes de que cada uno de nosotros se ha visto afectado de alguna manera por esta especie de relación confusa, como la describió usted, que tenemos ahora con este virus y durante la pandemia.

Y entonces existe la posibilidad y el riesgo de que algunos bajen la guardia porque esa perspectiva hacia arriba y hacia abajo, hacia arriba y hacia abajo, la colina y el valle puede ser muy desgastante y agotadora. Esa es la otra palabra que he escuchado mucho en el último año y medio: agotador, tanto a nivel personal como social.

Y así, tenemos que estar siempre y en todo momento en guardia, creo, para no volvernos demasiado complacientes durante los buenos tiempos, de modo que no seamos capaces de revitalizarnos y volver a los hábitos de seguridad que necesitamos durante los tiempos en que aparezca el delta o el ómicron o cualquier otra variante. Cuando sucedan esas cosas, tenemos que poder prepararnos para estar en nuestro nivel más alto de vigilancia sobre nuestra propia salud y seguridad, así como la de los que nos rodean.

También existe la posibilidad de que la gente tome una actitud indiferente y diga "ya hice todas esas cosas y me fue bien el último año y medio, y ahora delta y sobreviví y ahora ómicron, y va a seguir sucediendo y sucediendo. Entonces, ¿por qué molestarme en tomar medidas para estar seguro y protegerme a mí mismo y a los demás?"

Y tampoco podemos permitir que ese sea el tema predominante en nuestra vida. Así que, encontrar algo positivo, sé que he hablado en otros programas acerca de cada día tratar de encontrar algo positivo para lograr sentir que estoy en control de algunas cosas, pero no de todo. y, ya sabe, así se trate de cómo socializa con familiares y amigos de una manera segura, por supuesto, pero que se reconecten entre sí, lo que puede significar regresar al trabajo para algunos, o un mayor nivel de conciencia sobre el virus para otros. Que hay cosas sobre las que podemos hacer algo, tener el control y utilizarlas como guías para mantenernos centrados en lo que es positivo en nuestra vida.

No podemos controlar las mutaciones del virus, no podemos controlar si hemos estado cerca de alguien que, de hecho, puede estar infectado y transmitirlo, pero lo que podemos controlar es cómo nos manejamos en general durante esto, y estar atentos para comprender que la depresión, la ansiedad, el estrés, todas esas cosas nos han sucedido a cada uno de nosotros de alguna manera durante el último año y medio. Y que está bien decir que hoy no estoy bien, y pedir ayuda.

Bill Walsh: Buen consejo. Muchas gracias por eso, Dra. Stewart. Dra. Eckardt, hace un momento, uno de nuestros oyentes estaba preguntando sobre la eficacia de una de las vacunas y comenzamos a hablar sobre mezclarlas. ¿Qué consejo puede ofrecer sobre la mezcla de vacunas? ¿Tiene algún beneficio? Y, por supuesto, estamos en medio de la temporada de influenza, ¿existe algún riesgo de recibir la vacuna contra la COVID-19 al mismo tiempo que otras, como las vacunas contra la influenza?

Paula Eckardt: Creo que ahora sabemos más y nos sentimos más cómodos al mezclar las vacunas que en el pasado, que no teníamos la información. Entonces, nuestra práctica ahora es que si puede recibir la vacuna original que recibió, bien, aplíquese esa como refuerzo. Si no puede recibirla o no está disponible, puede mezclar. Por ejemplo, si tiene la serie Pfizer, luego puede recibir un refuerzo de Moderna. Y muchos de mis pacientes ya lo han hecho. Y no hemos visto ningún problema con eso.

Y creo que también es importante saber que con la temporada de gripe, al principio, había una recomendación de esperar al menos dos semanas entre las vacunas. Pero en este momento, la recomendación es recibir las vacunas, y puede recibirlas al mismo tiempo. De hecho, yo recibí las dos al mismo tiempo sin problemas. Entonces creo que la gente debería tener en cuenta que estamos en la temporada de invierno, y aquí es cuando vemos muchas de esas infecciones respiratorias, y todavía podemos ver la influenza.

Y la influenza todos los años ha enviado a mucha gente en el hospital y algunas personas terminaron muriendo. Por eso creo que es importante continuar vacunándose contra la influenza y recibir el refuerzo contra la COVID-19.

Bill Walsh: Bien, gracias por eso, Dra. Eckardt. Ahora es el momento de abordar más preguntas con el Dr. Aronoff, la Dra. Stewart y la Dra. Eckardt. Como recordatorio, presionen * 3 en cualquier momento en el teclado de su teléfono para conectarse con un miembro del personal de AARP y ponerse en la lista para hacer esa pregunta en vivo. Jesse, ¿a quién tenemos ahora en la línea?

Jesse Salinas: Sí, ahora vamos a responder una pregunta de YouTube. Tengo una pregunta de Lisa en Facebook. Y ella dice que esta pandemia le ha hecho tener problemas para mantenerse conectada con la gente, con el distanciamiento social y demás. Y ahora Medicare no acepta a su terapeuta de salud mental. ¿Hay opciones para ayudarla a conservar su terapeuta o ayudarla a encontrar uno nuevo?

Bill Walsh: Dra. Stewart, parece estar usted en una posición ideal para responder la pregunta de Lisa.

Altha J. Stewart: Sí. Y gracias, Lisa, por esa pregunta. Desafortunadamente, no hay una respuesta individualizada que pueda ofrecer porque estos son los tipos de problemas que son realmente regionales y estatales y, a veces, específicos a nivel local. En general, hay un par de cosas que le aconsejaría: que trabaje muy de cerca con el terapeuta para asegurarse de que han seguido todos los pasos necesarios.

Si hay alguna duda de que se vaya a prohibir, que hagan todo lo posible junto con el terapeuta para apelar esas decisiones utilizando la justificación basada en los motivos que los llevan a ambos a creer que mantenerse conectados es lo mejor para usted, desde la perspectiva de la atención médica.

Lo otro es que tanto usted como el terapeuta deben explorar lo que está disponible en su área en forma de apoyo de sus proveedores, dependiendo de la disciplina, su enfoque particular en la defensa de la atención en su área. y que conozcan lo que varios grupos de consumidores también están haciendo para asegurar que esas cosas permanezcan intactas, que esas relaciones permanezcan intactas.

Hay una gran actividad por parte de los proveedores y las organizaciones de consumidores durante este tiempo incierto que se considera eficaz en muchas áreas. La expansión de la telesalud como medio para mantenerse conectado y esas cosas son el resultado directo de que los proveedores y los consumidores se aseguren de que el mensaje es muy claro de que este es un momento importante para que no haya rupturas en ese tipo de relaciones. Entonces hagan todas esas cosas y lamento, no tengo una guía más específica para hacerlo, pero eso ayudará a comenzar en términos de abogar por lo que necesita.

Bill Walsh: Está bien.

Altha J. Stewart: Y buena suerte.

Bill Walsh: Muy bien, Dra. Stewart, muchas gracias por esa información. Jesse, ¿quién sigue?

Jesse Salinas: Vamos a tomar otra de YouTube, Bill. Esto es... Su nombre es Edna y dice: "Nos preocupa mucho la vacuna, porque tenemos material que dice que podría ser peligrosa para las personas mayores. Y por esa razón no me han puesto la vacuna. ¿Hay algo de verdad en eso, en lo que he estado viendo en línea?"

Bill Walsh: Dr. Aronoff, me pregunto si puede abordar esas preocupaciones. Estamos escuchando muchos mitos, diría yo, sobre lo que hay en la vacuna y lo que no. ¿Puede dejar las cosas claras?

David M. Aronoff: Seguro. Y quiero agradecerle a Edna por esa pregunta. Y creo que la pregunta realmente nos ayuda a pensar en el hecho de que las personas que aún no han sido vacunadas a menudo tienen preocupaciones muy diferentes. Y una importante que escuchamos una y otra vez es la cuestión de la seguridad.

Sabemos que estas vacunas pasaron por los estudios clínicos habituales de fase I, fase II, en grandes estudios de fase III con decenas de miles de personas, y no mostraron ningún problema de seguridad inesperado. Y ahora hemos usado las vacunas en todo el mundo en aproximadamente, creo que hemos administrado alrededor de 8 mil millones de dosis en Estados Unidos, hemos administrado casi 500 millones de dosis, creo que estamos en alrededor de 470 millones de dosis de estas vacunas.

Y hemos podido hacer eso bajo la atenta mirada de cada persona que ha recibido la vacuna, cada persona que ha entregado las vacunas y los órganos de supervisión habituales, como la FDA y los CDC, y nosotros realmente tenemos muy, muy buenos datos para demostrar que estas vacunas son muy seguras y eficaces en los adultos mayores.

A las personas les duelen los brazos, pueden tener fatiga y fiebre y sentirse mal durante unos días después de vacunarse. Y ahora estamos un poco acostumbrados al hecho de que esas son posibilidades, pero a menudo es solo nuestro sistema inmunitario que responde a la vacuna. Entonces, los ingredientes que componen la vacuna incluyen el aspecto operativo de la vacuna que está destinado a entrenar a nuestro sistema inmunitario sobre el virus de la COVID-19 para prevenir la infección, y luego cosas que son importantes para mantener la vacuna estable hasta que pueda hacer su trabajo.

Pero estos son ingredientes que se usan en muchos medicamentos, que se usan en otras vacunas, y tenemos un largo historial con su seguridad. Entonces aprecio la pregunta de Edna. Si hay rumores de que estas vacunas son peligrosas para las personas mayores, eso es mitología.

Bill Walsh: Sí, y, Dr. Aronoff, usted habló sobre lo que hay en la vacuna, creo que es importante hablar también sobre lo que no contiene, que es el virus vivo, ¿verdad?

David M. Aronoff: Ese es un punto muy importante, Bill. Y me alegro de que haya mencionado eso. Estas vacunas que estamos usando no son el virus vivo del SARS-CoV-2. En realidad están concebidas para entrenar a nuestro sistema inmunitario en una parte del virus, que se llama proteína de de pico, que es un poco como el velcro en la superficie externa del virus que es importante para que el virus provoque la infección. Así que estas vacunas tienen ingredientes que ayudan a dirigir nuestra respuesta inmunitaria contra la proteína de pico, pero no incluyen ningún virus vivo.

Bill Walsh: Bien, muchas gracias por eso. Jesse, ¿a quién tenemos ahora?

Jesse Salinas: Sí, nuestra próxima pregunta vendrá de Tom en Wisconsin.

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

Tom: Hola. Disculpe, mi pregunta es, he recibido las tres inyecciones. Soy una persona de alto riesgo. Y... ¿podría contagiarme en este momento? Esa era mi pregunta. Y luego otra pregunta es, ¿qué estamos haciendo con las enfermeras y los médicos que están tan abrumados con el trabajo que tienen frente a ellos?

Bill Walsh: Esas son buenas preguntas, Tom. Dra. Eckardt, Tom ha recibido tres inyecciones. Parece que corre un alto riesgo. ¿Cuánto tiene que preocuparse por contraer COVID-19 en este momento?

Paula Eckardt: Creo que todos tienen que mirar el área donde están ahora, si hay muchos casos de COVID-19 en su área, si hay un brote en este momento en el área, por ejemplo. En Florida, nosotros ahora estamos en un estado de bajo riesgo. Por lo tanto, si se encuentra allí, correrá un mayor riesgo. Si recibió su tercera inyección y no es una persona inmunodeprimida, es decir que no es un paciente con cáncer o alguien que toma medicamentos para debilitar su sistema inmunitario, lo más probable es que las vacunas sean eficaces y lo protegerán contra enfermedades graves.

Hay casos en los que las personas reciben todas las vacunas pero aún tienen la enfermedad y podrían terminar en el hospital, pero es menos probable que suceda en quienes recibieron la vacuna de refuerzo. Y quiero decir algo sobre el agotamiento de los médicos y lo que está sucediendo con la epidemia de atención médica, de estar cansados.

Hemos estado luchando contra la COVID-19 desde el 7 de marzo del 2020 en mi hospital, y creo que ha habido tantas cosas buenas que han surgido y, específicamente, el apoyo de la administración, en el sentido de que tenemos mucho apoyo para la salud mental y podemos comunicarnos cuando estamos cansados. Pero, sin embargo, cuando tenemos esos aumentos repentinos, es un poco difícil y solo hay que pensar en positivo todos los días, como decía el Dr. Stewart, ya sabe, un día a la vez y que vamos a estar bien.

Y creo que ahora tenemos más arsenal para tratar a nuestros pacientes que al principio no lo teníamos. Y fue muy frustrante. Entonces, en este momento, aunque todavía tenemos algunos pacientes que se agravan y terminan muriendo, nos sentimos más confiados en la forma en que tratamos a los pacientes y en la forma en que nuestro sistema está respondiendo a la pandemia, especialmente ahora que tenemos las vacunas.

Bill Walsh: Correcto. Muchas gracias Dra. Eckardt. Jesse, ¿a quién tenemos ahora en la línea?

Jesse Salinas: Nuestra próxima llamada es de Dale de Nuevo México.

Bill Walsh: Hola, Dale, bienvenido a nuestro programa. Continúe con su pregunta.

Dale: Mi pregunta es, ¿simplemente el cuerpo acumula un anticuerpo contra el virus si uno contrae el virus, no importa cuán leve sea?

Bill Walsh: De acuerdo. Pregunta interesante y muy discutida. Dr. Aronoff, ¿puede hablar sobre eso y cuánto tiempo podría durar la protección?

David M. Aronoff: Sí, Dale plantea una pregunta realmente importante. En primer lugar, una de las ventajas de la vacunación con respecto a la dependencia del tipo de infección natural para reforzar nuestro sistema inmunitario es que las vacunas nos proporcionan una respuesta inmunitaria muy uniforme, fuerte, específica y segura contra el virus del SARS-CoV-2.

La pregunta que realmente hace Dale es después de una infección, ¿qué sucede con nuestra respuesta inmunitaria? Y está claro que las personas que tienen COVID-19 asintomática, que es un número sorprendentemente grande de personas, pueden no tener una respuesta inmunitaria fuerte en comparación con alguien que está gravemente enfermo o bastante sintomático. De hecho, cuanto más fuertes son los síntomas, generalmente más fuerte es la respuesta inmunitaria. Y eso se ha demostrado ahora en muchos estudios.

Entonces, si alguien no sabía que tenía COVID-19 pero le hacen una prueba que demuestra que sí la tiene, en otras palabras, que han tenido COVID-19 asintomática, es realmente difícil saber qué decirles sobre qué tan protegidos están contra la reinfección. Y es probable que esa protección disminuya más rápidamente que si hubieran tenido una enfermedad grave, que nunca le desearíamos a nadie.

La vacunación soluciona este problema al darnos la misma dosis que nos da una respuesta inmunitaria fuerte y muy predecible de una manera mucho más segura que dependiendo de la infección. Así que espero que eso ayude con la pregunta de Dale.

Bill Walsh: Sí, muchas gracias por eso, Dr. Aronoff, lo agradezco. Jesse, ¿a quién tenemos ahora en línea?

Jesse Salinas: Vamos a traer a Winona desde Missouri.

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

Winona: Hola, gracias por responder mi pregunta. La semana pasada, mi nieta dio positivo en la prueba de COVID-19 y yo me estaba quedando en su casa. Así que fui el viernes pasado y me hice la prueba y dijeron que no... me dio negativo. Pero después de eso, me enfermé y ahora lo estoy superando. Tuve fiebre un par de veces. No tuve ningún dolor de cabeza. Tuve tos y todavía tengo ganas de toser. Así que estaba planeando volver a hacerme una prueba hoy. Así que me pregunto, ¿está demasiado cerca para volver a hacerme las pruebas hoy? ¿O está bien hacerlo? Y qué hay de... He recibido mis dos vacunas, y también me he puesto la vacuna contra la gripe.

Bill Walsh: Está bien. ¿Y cuándo dijo que se hizo la última prueba de COVID-19, Winona?

Winona: El viernes pasado.

Bill Walsh: Entendido. Bien, preguntémosle a uno de nuestros expertos. Dra. Eckardt, ¿qué sugiere para Winona?

Paula Eckardt: Bueno, con la variante delta, siempre sugeriremos probar de tres a cinco días después de la exposición, así que creo que si se hizo la prueba el viernes pasado y la exposición fue antes, definitivamente podría hacerse la prueba correctamente ahora. Creo que en realidad es muy importante para ella hacerse la prueba para averiguar si los síntomas que nos dice que tiene son o no de COVID-19, para que pueda recibir anticuerpos monoclonales o hacerse otra evaluación.

Además, debe asegurarse de no estar infectada. Y creo que también estaba preguntando cuándo puede recibir el refuerzo. Entonces, si está infectada en este momento, tendrá que esperar hasta que ya no sea infecciosa. Por lo general, alrededor de 10 días después de que comenzaran los primeros síntomas, dependiendo de la gravedad de la enfermedad, pero generalmente son 10 días.

Y luego, después de eso, posiblemente podría obtener su refuerzo. Si se le administran anticuerpos monoclonales para, ya sabe, porque tiene una enfermedad leve y su médico se lo recomienda, entonces el retraso de la vacuna podría ser de 90 días. Pero definitivamente tiene que ponerse en contacto con su proveedor de atención médica y decidir si se hace la prueba lo antes posible.

Bill Walsh: Está bien, Dra. Eckardt, muchas gracias por eso. Y gracias a todos nuestros expertos por estar hoy con nosotros. Ha sido una discusión realmente informativa. También voy a agradecerles a nuestros miembros, voluntarios y oyentes de AARP por participar en la discusión de hoy. AARP, una organización de membresía sin fines de lucro ni afiliación política ha estado trabajando para promover la salud y el bienestar de los adultos mayores de Estados Unidos 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 evitar que contagien a otras personas mientras se cuidan. Todos los recursos a los que se hizo referencia hoy, incluida la grabación del evento de preguntas y respuestas, se pueden encontrar en aarp.org/coronavirus a partir de mañana 10 de diciembre.

Una vez más, esa dirección es aarp.org/coronavirus. 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 la próxima semana, el 16 de diciembre a las 7 p.m. hora del este para participar en una teleasamblea especial con el Dr. Francis Collins, el director de los Institutos Nacionales de Salud. Él nos contará lo último sobre el virus y las vacunas y responderá sus preguntas en vivo. Esperamos que puedan acompañarnos. Gracias y que tengan un buen día. Con esto concluye nuestra llamada.