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AARP Coronavirus Tele-Town Hall From May 5

Experts answer your questions related to COVID-19

Bill Walsh: Hello. I am AARP Vice President Bill Walsh. And I want to welcome you to this important discussion about the coronavirus. Before we begin, if you'd like to hear this telephone town hall in Spanish, please press *0 on your telephone keypad now.

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. Americans are relieved that after more than two years under the cloud of COVID-19, pre-pandemic activities are resuming and people's lives are returning to a semblance of normalcy.

While we hope the worst is behind us, experts believe there could be lingering effects to our bodily health and our mental health for quite some time. They say that exercise, stress management and mental health care are more important than ever. And as we transition into this next phase of the pandemic, many people have questions around balancing safety with their desire to socialize and do the things they used to love to do.

Today we'll hear from an impressive panel of experts about these issues and more. We'll also get an update from Capitol hill on legislation affecting older Americans. If you've participated in one of our Tele-Town Halls in the past, you know this is similar to a radio talk show, and you have the opportunity to ask your question live.

For those of you joining on the phone, if you'd like to ask a question about the coronavirus pandemic, press *3 on your telephone to be connected with an AARP staff member who'll 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.

Hello. If you're just joining, I'm Bill Walsh with AARP, and I want to welcome you to this important discussion about the global coronavirus pandemic. We're talking with leading experts and taking your questions live. To ask your question, please press *3. And if you're joining on Facebook or YouTube, you can post your question in the comments.

We have some outstanding guests joining us today, including a mental health expert and neurosurgeon. 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.

Again, to ask your question, please press *3 at any time on your telephone keypad to be connected with an AARP staff member, or if you're joining on Facebook or YouTube, drop your question in the comment section.

Now I'd like to welcome our guest. Samoon Ahmad, M.D., is a clinical professor of psychiatry at the NYU Grossman School of Medicine. He's also the founder of the Integrative Center for Wellness. His new book is Coping with COVID-19: The Mental, Medical, and Social Consequences of the Pandemic. Welcome to the program, Dr. Ahmad.

Samoon Ahmad: Thank you so much. It's a pleasure to be here.

Bill Walsh: All right. It's a pleasure to have you.

Brijesh Mehta, M.D., is the director of neurointerventional surgery at Memorial Neuroscience Institute in Florida. Welcome to the program, Dr. Mehta.

Brijesh Mehta: Thank you very much. It's an honor to be here.

Bill Walsh: All right. Thank you both for being here. And just a reminder to our listeners: To ask your question, please press *3 on your telephone keypad or drop it in the comment section on Facebook or YouTube. Let's go ahead and get started. Dr. Ahmad, a worldwide pandemic, of course, is not a typical experience of aging. How has the stress and uncertainty of the last two years affected older adults?

Samoon Ahmad: Well, I would say that the stress of the pandemic has been difficult on everyone. And I would include myself in that equation. And I think it's important to express my own concerns so that it would be important for people to understand that I was working at the time at Bellevue Hospital in New York City. And I got COVID very early on. In fact, it was March of 2020, and there was so much uncertainty, no idea about what the impact would be, how to treat this condition.

So it was pretty terrifying, and it was like a mystery disease at the time. And then last year, during the pandemic, I lost my father, who was in his 90s. So I can understand when you use the word “stress” and “uncertainty,” it's a [unintelligible] and it's very close to my heart and I've experienced it myself.

Now, that said, I think the circumstances for seniors have been uniquely difficult, and there are numerous reasons why, but I would like to focus, I think, on the important ones, which are two. The first is that COVID-19 tends to be more severe in older individuals. So it's pretty natural that a lot of seniors need to be and are in fact more diligent when they are thinking about or planning to see friends and family. And oftentimes they do take that into consideration, that the risk of attending an event may be too high for them. So they choose — I don't know how many people are going to be there, is it a closed environment, how am I going to interact. So they choose not to go.

Now, it's OK if you skip one or two events; that's not going to be a big deal. However, when you start missing major holidays, birthdays, other milestones with your family, it can lead to a feeling of loneliness and despair. And I would say that like so many other problems that arose during the pandemic, loneliness among seniors even existed well before 2020, particularly in the U.S. But you know what happened? This kind of continued isolation I'm describing is weighing particularly heavily on seniors at this point.

Secondly, people over the age of 65 make up about 75 percent of all COVID-19 deaths, even though they are only around 16 percent of the population. And COVID-19 deaths have been also more common in older men than older women by a margin of around, I would say, 50,000. Now, what this means is that far more older women, particularly older women of color, have lost a spouse. And this is emotionally difficult, of course, but it's also difficult for a variety of other reasons.

Bill Walsh: Doctor, you have talked about some of the emotional risks associated with COVID-19, the isolation, et cetera. I was wondering if we could also talk about another risk, and that's the unmet health needs. Of course, a lot of people put off regular appointments with their doctor because of the pandemic. They were  too nervous about going into a medical environment, and health experts say it's critical that older adults resume this sort of preventative care and screenings. What are the most important preventative screenings for older adults? Dr. Ahmad, why don't you start in, and Dr. Mehta, I'll ask you as well.

Samoon Ahmad: Right. So when you think about preventative screenings for older adults, their normal battery of tests that they're very accustomed to when they see their doctor. But I think you can look for certain signs and symptoms if you're looking in friends and family, or for yourself, if you're caring for someone who is significantly older. And I think it's important to think about that older adults as a single group, when you're around 60 — I myself am 60 and my father was 90. So we have very different pandemic experiences. And we should be screened for different things for those of us older, but still close to the middle age group should be screened for anxiety, for depression, prolonged grief disorders.

And you don't do this just by noticing sad feelings. Rather, you may notice a lack of interest in doing things and irritability. There could be more increased alcohol consumption or drastic changes in weight or sleep patterns. Now, for people who are closer to my father and that age group, the symptomatology can be a little different, and you should always look for things like changes in weight and declining interest.

But the important thing is, in that age group, cognitive problems are a major symptom of, particularly, depression in people of advanced age. And whereas the symptom is rarely observed in younger individuals. In fact, within the field of psychiatry, we call it pseudodementia. And it almost mimics that picture, and patients seem to be losing their cognitive and intellectual faculties, but when you treat them for depression, suddenly the symptoms disappear, which actually tells you that, no, this is not something that's an organic cause for dementia or anything. These are just symptoms that mimic. And that's a very important one, because spouses can notice — the grandchildren, children or anybody can — something is going off that you're having a difficult time remembering things or where the misplaced things are, or they're not tending to their bills on time, any of those things. So it depends upon what age group, but that's one way to do preventive screening.

Bill Walsh: Thanks so much, Dr. Mehta. Did you want to add to that list? Preventative screenings that people should be doing at this point?

Brijesh Mehta: Yes. So I agree with Dr. Ahmad that, especially during the pandemic with the social isolation, mental health is certainly at the forefront right now. And especially if a patient's, individuals, had pre-existing conditions, that, studies have shown, has been exacerbated over the past two years.

And so it's certainly resuming, through preventative services, some of the screening, for cognitive issues, anxiety, depression, like you said, is paramount. And from a cardiovascular, cerebrovascular standpoint, it's also important as patients, population in general, becomes more comfortable going back to the hospital, back to the clinic to be seen by their primary care provider, to be screened for risk factors for diabetes or high blood pressure, hyperlipidemia, meaning high cholesterol, as well as smoking counseling, particularly if they tended to increase or worsen their smoking habits during the pandemic. Any of these conditions and addictions should require some form of counseling and preventative care, including medication compliance.

Bill Walsh: Yeah, thanks so much for that. Let me follow up. Dr. Mehta, according to the Journal of the American Medical Association, the incidence of heart attacks and strokes had been declining prior to the pandemic, but now has reversed course, with exaggerated differences among minority populations. Why are we seeing so many heart issues related to the pandemic, and why are Black and brown populations facing a higher risk?

Brijesh Mehta: That's a great question. In the state of Florida, where I practice, through the Florida Stroke Registry and similar consortiums, we've looked at health care disparities, especially within the minority populations, and what we have learned is that it’s multifactorial. There are reasons behind it that should be addressed through epidemiological measures, such as overall access to preventive services that we just discussed, as well as financial ability to afford going to the doctor, paying for medications and, specifically for stroke, secondary stroke prevention is very important.

We have noticed, especially in the last two and a half years over the pandemic, that after a patient suffered in initial TIA or an actual stroke, that their compliance and ability to follow up on a regular basis and where we could ensure that they were on the appropriate medications, that trended down.

And there's also, especially among African Americans and other minority populations, I think there has been, unfortunately, a baseline mistrust of the health care system, and especially of authority figures, and that has been reported over the last several years, and something that we, as medical authorities, health care institutions are actively working on trying to reassure them that we are in the interest of treating their health, their families, and that we mean the best for thei, chronic illnesses.

Bill Walsh: Well, let me talk about some of the other complications related to COVID. Of course, the CDC recently reported that 60 percent of the U.S. population had been infected with COVID-19 at some point. Now, complications from COVID-19, even in mild cases, have included things like blood clots, heart disease, stroke, as you were just saying, and diabetes. What are the long-term risks, Dr. Mehta, if you've had COVID?

Brijesh Mehta: Yeah, so we're continuously learning more about the fact of long COVID, if you will, and what are the various multisystems that it could span and affect. And, particularly in my specialty, in neuroscience neurosurgery, what we have seen as lingering effects of COVID and, even in folks who initially may have been asymptomatic, is, as Dr. Ahmad alluded to earlier, depression, anxiety, just generalized fatigue, malaise, some of these symptoms we've seen in about 30 to 40 percent of our COVID-infected patients. And the etiology as to why we're seeing it in this population, weeks and months out after an initial infection, we're still learning, but it has something to do with persistent, ongoing autoimmune response and inflammation within the blood vessels.

Particularly at the height of the pandemic, similar to what scientists noticed in the Northeast, we also saw in Florida the increased risk of stroke among patients who were suffering from COVID. And unfortunately, those patients, despite acute intervention, had worse outcomes, inability to open up those arteries due to clotting disorders as a result of COVID.

Bill Walsh: Well, let me follow up on that. You mentioned stroke. I'm wondering if you could quickly share the warning signs that should prompt someone to contact their physician if they feel they might've had a stroke or maybe they've seen a loved one who is suffering some of those symptoms.

Brijesh Mehta: Sure, absolutely. May being stroke awareness month, we're doing everything possible in our local community and beyond to educate the patients and those at risk about stroke signs and symptoms. So, the acronym that we use, and it's been championed by the American Stroke and Heart Association, is called BE FAST. So, Balance, Eyes, Face, Arm, Speech and Time. So, if an individual has sudden onset of difficulty with their walking, maintaining their balance, trouble seeing — all of a sudden there's a field cut within their vision or double vision — difficulty with their facial expressions. And it's usually the loved ones that pick up on some of these subtle clues, such as facial droop, asymmetry of their face. And let's say they're holding a pen or a cup of coffee, and all of a sudden they have weakness in that arm or hand or difficulty getting words out, which is the speech part. Essentially, time is of essence.

And we encourage family or individuals that may be suffering the signs or symptoms to call 911 immediately, as every minute that lapses after onset of stroke-like symptoms, about 2 million neurons are at risk for permanent damage. So the faster they seek care, the better the potential outcome.

Bill Walsh: OK, thanks so much for that, Dr. Mehta. Now, we've been talking about some of the physical complications associated with COVID-19. Let me talk about some of the mental health issues. In a recent AARP survey, we found that more than 30 percent of older adults have been bothered by anxiety, have had little interest or pleasure in doing things, and have experienced feelings of depression or hopelessness. Four in 10 say they aren't able to easily bounce back from hardship. Dr. Ahmad, where do older adults turn for help if they're having feelings of hopelessness, loss or depression?

Samoon Ahmad: Well, I think the first place, in my opinion, they should turn to when at the same time it should be reciprocated by, is the families. But particularly, I would say among younger people at this point there is far less stigma about problems with mental health, and the pandemic has even made it more socially acceptable to have this conversation.

So, talk to children, talk to grandchildren. They are going to be far more empathetic than we think they are. And if you don't feel comfortable talking to the family, or you think that you need help from a mental health professional, licensed therapists are trained to help people struggling with depression, anxiety or a general sense of malaise, while specially trained grief counselors can help those who have lost someone close to them.

I would first suggest to talk to the primary care physician and ask for recommendations. And if you want to explore, then, other options, ask neighbors, associates and friends whom you trust, and if you are more of a religious person, I would recommend speaking to the leader of your congregation. They often have a very strong background in counseling and offer comfort to those who feel rudderless or lost. And they can also recommend, in fact, a mental health professional for you. Finally, I think things like stress levels, the amount of sunlight you get, how many hours you sleep and diet can really impact your mood.

In fact, there was a review and analysis that showed that in an enormous amount of data, about 2 million person year, found that people who got a moderate amount of exercise, which is equivalent to about two and a half hours per week of just brisk walking, were far less likely to be depressed. And I think it's important to think that a lot of people like to compartmentalize their body and mind, but the two are intimately connected, and you can end up feeling quite oppressed and depressed by negative feelings if you're not living a healthy lifestyle. So, therefore, I would consider, in fact, joining some sort of either a senior center or other place. And when exercise I don't want people to get the impression I'm talking about something hard and tiring. No, I'm just talking about normal physical activity, brisk walking, gardening, going for some cycling, taking a cooking class or healthier meals. You just need about 30, 40 minutes just to sort of go out and do things. But that would be one way to start. I would say to start, whether it's your neighbor or your friend or a family or a PCP who can recommend and be someone who can make that referral for you.

Bill Walsh: OK. As a reminder to our listeners, if you'd like to join the conversation and ask your question live, press *3 on your telephone keypad at any time. And if you're on Facebook or YouTube, just drop your question into the comment section.

Now, Dr. Ahmad, sometimes mental health treatment is stigmatized as if it were a sign of weakness. Have we seen improvements related to that during the pandemic, and how can trust and awareness be established, particularly with ethnic communities where there is a great deal of distrust?

Samoon Ahmad: Well, I think number one, there's no question that compared to where we were and where we are at this point, there has been a sea change at this point compared to what existed before. So I think I would say that people are seeking a lot more help at this point. People are talking about, they bring up many times physical symptoms, and once you start talking about physical symptoms — I try to sort of make that connection between the mental and the physical and the reciprocal relationships between the two — people are lot more open. And there is a sea change in terms of virtual health care, which is also available at this time. Now, it doesn't in any way substitute for actual in-person meeting. But people are a lot more willing to sort of sit in the comfort of their home, because they are concerned about going out or being with another person, the risk. So from that perspective as well, people are a lot more open in terms of being able to seek help.

Bill Walsh: Great, well, that's great news. And thanks for that update, Dr. Ahmad. Let's talk a little bit about resources that people can use. This is a very important discussion, given that May is mental health awareness month. I wanted to remind them that AARP has some excellent free mental health tips and tools and resources that can be found on our Mental Health Resource Center. That address is www.aarp.org/mentalhealth, all one word, so www.aarp.org/mentalhealth. Or if you're feeling isolated, in need of a friendly voice, please call AARP's Friendly Voice toll-free line at 888-281-0145. That's 888-281-0145. Once again, that's a free service in English and in Spanish. And as a reminder to our listeners, to ask your question of our experts today, please press *3 at any time on your telephone key. Or drop your questions in the comment section of Facebook or YouTube.

We're going to take those live questions soon. But before we do, I wanted to bring in Megan O'Reilly. Megan is the vice president at AARP for health and Family. And she's going to be updating our listeners about how AARP is fighting for them. Welcome to the program, Megan.

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

Bill Walsh: All right. What's the latest news on the advocacy front?

Megan O'Reilly: AARP’s top priority continues to be our fight to lower prescription drug prices for older Americans. Recent polling shows this is the number one health issue voters want Congress to tackle this year. And it's our number one issue, too. For years, Congress has promised to address the skyrocketing price of prescription drugs. And we're finally on the cusp of seeing change. We've never been this close to major prescription drug reform, and it needs to pass now.

Bill Walsh: OK. Well, what kinds of prescription drug reforms are we pushing for?

Megan O'Reilly: Above all else, we want Medicare to be allowed to negotiate for lower drug prices. We also want to put a cap on out-of-pocket costs for older adults for what they're paying for their prescription drugs. We want to see penalties imposed on drug companies that raise their prices faster than the rate of inflation.

Seniors are sick and tired of paying the highest prices in the world for their medicines. And they want relief. In fact, we know more than 80 percent of voters across parties support these reforms that would help families afford medications and save taxpayers billions of dollars each year.

Bill Walsh: OK. Now, just this week, AARP also endorsed legislation expanding at-home care for veterans. What can you tell us about that?

Megan O'Reilly: Absolutely. AARP endorsed the Elizabeth Dole Home and Community-Based Services for Veterans and Caregivers Act of 2022. This legislation would expand access to and improve coordination between VA programs. And it would also improve support for veterans and their family caregivers.

Bill Walsh: Now, why is that so important, Megan?

Megan O'Reilly: Veterans should be able to remain living in their homes for as long as possible. And this legislation would help them do that. After serving our country, these men and women deserve to live with independence, security and dignity. AARP is fighting for all veterans to have high-quality affordable options when it comes to long-term care, especially their care at home.

Bill Walsh: OK. Now, finally, if our listeners want to stay on top of AARP’s advocacy news, how can they find out the latest updates?

Megan O'Reilly: It is so important to stay on top of the issues affecting you and everyone age 50 and older. We would encourage you to go online and search “AARP Fighting for You. That will point you to a daily roundup of the latest advocacy, news and updates. It's a great way to stay informed, and we encourage everyone to check it out.

Bill Walsh: OK, great. So search AARP Fighting for You. Got it. Thanks so much, Megan, for being with us today.

Megan O'Reilly: Thank you, Bill.

Bill Walsh: All right. And as a reminder to our listeners, press *3 at any time on your telephone keypad to ask your question to our mental health expert and our neurosurgeon who are on the line and waiting to answer those questions today. It's now time to address those questions with Dr. Samoon Ahmad and Dr. Brijesh Mehta. As I said, press *3 at any time on your telephone keypad to be connected with an AARP staff member to get into the queue to ask your question live. And if you'd like to listen in Spanish, press *0 on your telephone keypad now.

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

Jesse Salinas: Thanks so much for having me today, Bill.

Bill Walsh: All right, who do we have first?

Jesse Salinas: Our first question is going to come from YouTube. This is from Craig in Oklahoma, and his question is: My family has a history of stroke. Am I at a higher risk due to COVID, or what should I do to protect myself?

Bill Walsh: That sounds like a great question for Dr. Mehta. Dr. Mehta, can you answer that one for us?

Brijesh Mehta: Yeah, that's a great question. So, if a person has a family history of a stroke, whether it's due to blockage of an artery in the brain or due to bleeding in the brain, those are both considered the various subtypes of strokes. And it's important when they are evaluated by a neurologist, ideally, a stroke neurologist, or their primary care doctor, that some of those risk factors for why their family members had strokes are clearly identified, such as preventable issues like high cholesterol, high blood pressure, diabetes, smoking. And if any of the patients or family members have similar risk factors, then that is the right time to get those under control, either through lifestyle modifications and or exercise and medication compliance.

And if despite those kinds of interventions, it's still difficult, sometimes genetics does play a significant role. Then it's important to be on the right medications and also undergo some additional workup, given the various etiologies, causes, of strokes, such as blood clotting, to make sure we identify those, especially at a young age, so that you can live a long, healthy life. COVID, we know, certainly increases the risk of stroke regardless of family history and so forth. And when patients have COVID, unfortunately, it's not fully understood why some patients experience blood clotting issues and others don’t, but once it's identified, it's important to be on blood thinners and also to make sure that any underlying health care conditions, such as diabetes, obesity or high blood pressure, are modified as much as possible.

Bill Walsh: All right. Dr. Mehta, thanks so much for that. Jesse, who do we have up next?

Jesse Salinas: Our next question is going to be from Ted in Nevada.

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

Ted: I wonder about how much sleep do I need. I have all the symptoms. Is more sleep helpful?

Bill Walsh: Is more sleep helpful for preventing COVID or treating COVID or, is that your question?

Jesse Salinas: I think that's it.

Bill Walsh: All right. OK. Dr. Ahmad, I wonder if you can talk about the importance of sleep, the need for sleep and maybe it's someone recovering from COVID.

Samoon Ahmad: Right. So, I think in some ways the caller hit the nail on the head, that sleep is one of the most fundamental, essential needs. And, in fact, many people who struggle with depression, anxiety, one of the main things that is a comorbidity is sleep problems in those patients. And sleep by itself obviously is just a symptom of an underlying condition, and people who don't sleep well or have difficulty, apart from being about anxiety and depression, I want to emphasize, and Dr. Mehta, I can explain more, but those people lead to more stress. It leads to more stress. And stress, in fact, then leads to this cascade, of all kinds of various hormones and neurotransmitters that predispose an individual over a prolonged period of time to many of the chronic ailments, including heart attacks or high blood sugar or diabetes or obesity or inflammation in the body, which also causes neuroinflammation, which then can predispose you to not only psychiatric conditions, anxiety, depression, but many other conditions which may have to do with cognitive disorders, Parkinson's disease and others.

So addressing sleep is essential, both psychologically as well as mentally, because to think of anything that's happening in your mind as if it stays above the neck, things that happen above the head — it's not like Vegas, what stays in Vegas. It has reciprocal relationships throughout the body, and it's essential to actually address those. So people that have chronic ailments will have sleep problems without a question. And if one is obese or you have more weight, sleep apnea can sometimes actually predispose you and you have more risk of hypertension in that. So people with mental illness or other conditions can have sleep problems. People that have many physical ailments, they'll have sleep issues. And then they reciprocate and have issues in terms of all of the chronic ailments that I just mentioned.

Bill Walsh: OK. Thanks so much, Dr. Ahmad for that. Jesse, who is our next caller?

Jesse Salinas: Our next caller comes from YouTube. L.M. asks: Since the COVID pandemic, my anxiety has increased. What are some tips to cope with that type of anxiety?

Bill Walsh: Dr. Ahmad, you seem suited to answer this question. Too.

Samoon Ahmad: Yup. So, you're absolutely right. I mean, usually the baseline prevalence of an idea is about 7 percent, 8 percent. Now it's happening at 39 to 40 percent, and the symptoms of anxiety, most of the times people are experiencing, which is natural at this point. But I think some of the coping strategies that people can incorporate into their life, I specifically talk about breathing exercises.

People tend to just sort of disregard the importance of breathing, and the reason I'm bringing up the issue of breathing is because breathing increases sort of what we think about in the body is the braking system of the body. It sort of slows our heart rate. It reduces the stress overall. So taking time, I would say about 10 to 15 minutes, three times a day, what we call it, the dominant breathing, for example, which is you sit down in an upright position and you inhale as much as you can deeply, try to hold your breath and then exhale for twice as long as your inhalation. Try to visualize a scenic or a beautiful place that usually you like to go and visit and try to do this. That's one way to manage.

The second would be what we call a muscle relaxation technique. And the idea is, again, to sort of sit in an upright posture and think of from your toes all the way up to your neck, you are putting your muscles into extreme contraction, holding them for a little period of time, and then sort of let them go suddenly. And then that's release, but apart from that, there are other things, where doing things outside, physical activity. That's one way to mitigate stress as well. Meditation, yoga. Those are some of the other strategies that you may want to think about. So I think lifestyle changes overall are an extremely important element of reducing anxiety.

Besides the fact that you may want to talk to someone or seek help, or in cases where it's to the point where you are having difficulty functioning personally, professionally, you may need to seek professional help for some other medical treatments.

Bill Walsh: OK. Thanks so much for that, Dr. Mehta. Jesse, let's take another question.

Jesse Salinas: Yep. Our next question comes from Sue in New York.

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

Sue: I have a cardiologist who just wants to do a routine stress test, and they wanted me to take the medication one. And I said, no, that's crazy. 'Cause I have a bad knee, but I think I could do the other one. But the point is I don't want to go into the hospital and have this done. And there's no reason for it.

I do not have any preexisting conditions. I mean, I have GERD and hiatal hernia and fibromyalgia and hypothyroidism. I don't have any heart conditions. Now, my dad did die of a stroke at the age of 70 and I am 72, but I don't want to take the risk because COVID is very high here. Why would he be asking for this?

If, I think, I took an electrocardiogram, and it was fine and there were no problems. He said that. Why do people have to have a routine stress test? Is it something you have to have at a certain age? And why would I want to do that now?

Bill Walsh: All right. Well, let's ask Dr. Mehta. Dr. Mehta, can you help Sue?

Brijesh Mehta: Hi, Sue. That's a good question. And it’s certainly worth questioning the indication for a cardiac stress test. Unless you're having some ongoing symptoms, such as chest pain during exercise or even during daily activities such as walking, working around the house, I do not, from what you have described, see a strong indication to undergo a cardiac stress test. It is not part of the routine U.S. [Preventive Services] Task Force guidelines for older individuals, i.e., those above 65 years of age, to undergo cardiac stress tests, unless you're having any of the symptoms, such as chest pain and shortness of breath on exertion, meaning with routine activities. …

As far as concerns about going into the hospital, because of COVID surges, I certainly sympathize with that concern. You know what, I can reassure you just from a health care institution standpoint, any facility that is managing patients in the United States has undergone extensive training, and safety protocols are in place to make sure that patients, when they come in for any other medical problems management, that they're kept safe. And all the staff are trained to keep those environments separate from the COVID units and also have the appropriate PPE on hand. So just wanted to reassure you about that.

Bill Walsh: OK. Thank you for that, Dr. Mehta, and thanks for all those questions, we're going to be taking more of your questions. And as a reminder, if you'd like to get in the queue and ask your question live, press *3 on your telephone keypad at any time.

Dr. Ahmad, I wanted to get back to you. We've seen in recent years increasing options for online or virtual mental health, done remotely through your computer or a tablet. Is virtual mental health able to replicate the in-person treatment? Is it effective?

Samoon Ahmad: The short answer, no. But I would say talk therapy, which is [the] most common use of telehealth and is largely based on verbal communication, therapists are able to put together a lot of information. But I would say if you are trying to assess in terms of some of the symptomatology that we like to see, for example, a person who is sitting complaining of anxiety, but you see they’re literally trembling, shaky, you really can't assess such things while you are on a telehealth platform. In person, as human beings being social animals, we like to connect with people more in person, though, the visual cues being in close proximity to another person, getting their facial expressions in person rather than on a Zoom or FaceTime, two very different ways of communicating. So I think during the last two years, obviously, because of the concerns, I think it did a great service. There's no question about it. It was … patients were able to get significant help. So I am not in any way minimizing that, but I would say that if there is a choice and if people are able to manage, I would still suggest in-person treatment at this point.

Bill Walsh: OK, thanks for that. And let me quickly follow up. I wonder about the cost considerations. Is mental health telemedicine covered by private insurance or Medicare?

Samoon Ahmad: Well, there for a time, yes. Then there was a sort of question came into being that we need to stop that, but by some patient advocacy and a lot of support and people still being quite concerned about it, most insurances, even Medicare, are covering partially or to a significant extent the use of telehealth medicine. But to go into the private insurances, it varies across, for example, at one point across state lines, people who are allowed to use, and that's becoming a little bit more limited. At one point it was completely expanded so that people could get adequate help. So there are a lot of variables, but it's difficult to answer question in purely yes-and-no form, but yes, in the way the system is right now, Medicare does cover. To a certain extent, so do private insurances.

Bill Walsh: OK. Thanks for that. Dr. Mehta, let me turn back to you. Last year, the FDA approved powerful COVID antiviral drugs, and we're now seeing an increase in production and availability. What are antivirals, and why do they matter?

Brijesh Mehta: Bill, that's a good question. So antivirals, they have been around for a good part of the last 50, 60 years. And they work, basically, by binding to receptors within the cells of our body that may be infected with the virus, and they prevent the virus from replicating within those cells. And most of the antivirals on the market, some of our listeners will be familiar with, for example, the influenza antiviral medication Tamiflu. And now with COVID, as you mentioned, there’s been approval by the FDA of the Pfizer antiviral is called Paxlovid.

And basically the goal is to prevent any worsening of COVID symptoms into more severe disease that kind of affect our lungs, heart and, as we have discussed, other parts of our body, including the brain. The key thing is to take it within the first few days of symptom onset. And keep in mind, this is not approved for any and all patients that become infected with COVID. It’s for those who are at particularly high risk. That category is defined as those adults 65 and older, and those with certain underlying health conditions, such as heart disease, cancer, diabetes or obesity. And so it's not a substitute for getting vaccinated. This is for patients who are in that high-risk category and get afflicted with COVID. It can certainly prevent some of the downstream sequela.

Bill Walsh: Now, let me ask you, at this moment in time, it seems like COVID is abating, hospitalizations are down, et cetera. For people who did not receive a vaccine, or they couldn't get a vaccine because the systems were compromised for some other reason, how do they manage social activities and exercise now? What advice would you give them at this point in the pandemic?

Brijesh Mehta: Right. I think it’s important to emphasize to those individuals that just like during the worst surges of the pandemic, that this still comes down to our individual responsibility. That while we may be out of the worst part of the pandemic in terms of caseloads and overwhelming the health care systems, it comes down to making sure that we still continue to mask, especially in highly concentrated areas, social gatherings. And particularly if you're experiencing symptoms to exercise that responsibility, to ensure that you follow the CDC guidelines for quarantine, especially in the first few days after symptom onset, and practice that social distancing. And wearing a mask is still very helpful and the most effective preventative measure in terms of protecting our loved ones in the community.

Bill Walsh: Now, of course, we've seen so many masks come off in recent weeks. If you're the only person in the room wearing a mask, is there any benefit?

Brijesh Mehta: Certainly, we've all been in situations where, depending on our kind of individual comfort level, as well as uncertainty about who may or may not be symptomatic, and we make that personal choice to wear a mask. It’s still very helpful because a mask, as data has shown, can reduce the overall inhalation of these aerosol droplets, which is how COVID is transmitted, by 50 to 70 percent.

And so having a multilayer cloth mask, even if you’re the only one in the room wearing it, you're essentially protecting yourself as well as, when you're talking or just in part of normal conversation, if you're experiencing symptoms and unknowingly may be infected with COVID, you’re also protecting others from catching it.

Bill Walsh: Right. OK. And last question for you, Dr. Mehta, I wonder, can COVID directly harm the brain? A recent study in the Journal of Psychiatric Research found that some folks have become more forgetful and slower to process information following COVID. Is this COVID fog long COVID or something else? And what's the cause? What should people know about that?

Brijesh Mehta: That's a great question. And I'm sure Dr. Ahmad can add to this as well. What we have seen in our neuro follow-up clinics, especially those after a stroke that we tend to see who may have been infected simultaneously with COVID at the time of initial admission, we're seeing and hearing from our community neurologist that these patients are presenting with cognitive issues like you said, forgetfulness, difficulty performing the simplest activities of daily living that we all take for granted, balancing checkbooks, tasks around the house. And we are in the process now of still learning more, as part of national studies, but it is certainly something that, as we were discussing earlier, has to do with ongoing inflammatory response that damages the neurons in the brain and that persistent sort of autoimmune response is what's causing these long-term effects, and it's not something to take lightly. And we're logging these patients in our clinic as part of our screening to see who is still being afflicted with these long-term symptoms and continue to learn from it.

Bill Walsh: OK. Thanks so much. Dr. Ahmad, I don't know if you wanted to weigh in on, on the notion of a COVID fog.

Samoon Ahmad: Right. I completely agree with Dr. Mehta. I would just expand what he just mentioned, the word inflammation, neuroinflammation, because you would think about it, from even purely cognitive effect, somebody who's unable to do what they were so used to be doing all the time or for a protracted period, now they're seeing their life sort of become so limited. Thinking about that in itself is going to make you feel very anxious and depressed that you are not able to do [what] you were once [able to] in life and professionally, personally, it [impacts] you. Secondly, inflammation, as I mentioned, the neuroinflammation, and we now understand anxiety, depression are not just figments of the imagination, this neuroinflammation underneath is responsible for these disorders.

So how, as Dr. Mehta expanded, microclots in the brain and inflammation that's happening, one can think of that maybe there are some underlying, predisposing factors, which lead to this anxiety and depressive symptoms as well. So it's sort of a back and forth, I think, between those two. That's the paradigm, I would suggest, that one affects the other.

Bill Walsh: Sure. That's a great observation. Thanks to you both. Now it's time to address more of our listener questions with Dr. Samoon Ahmad and Dr. Brijesh Mehta. Please press *3 at any time on your telephone keypad to be connected with an AARP staff member to get in the queue to ask your question live. Jesse, who do we have next on the line?

Jesse Salinas: Yeah, our next question comes from Facebook. It's Lisa in Virginia, and she says: What can I do for my loved one who is showing signs of depression but seems to be in complete denial about it?

Bill Walsh: Dr. Ahmad, what would you say?

Samoon Ahmad: I would say not unusual. And people tend to feel and, very common, that somehow it's a weakness of my character, weakness of my personality. I can beat this. I don't need any help. And I think the most important thing is to just show your presence and show your love, show your affection and be a listening person or that your shoulder anybody can cry on, that constant presence. And just being around to offer help, not in a technical or professional way, but just chatting up and starting some conversations, making another person feel comfortable. That in itself can be at times where people don't feel judged. People don't feel that you are forcing them into a particular situation. And sometimes it's even helpful to share a personal vignette or a story as to what, how you have struggled in life at some point during the conversation and how you have dealt with it and how difficult it was for yourself and how you overcame that. And so the other person doesn't feel singled out, doesn't feel criticized, doesn't see that they are unique and the only one struggling and suffering in this. And that kind of open-ended engagement and conversation can be very helpful for the person, unless you find that that person is incapable of tending to the needs or is exhibiting symptoms that may be sort of potentially dangerous, any suicidal thoughts or anything, then obviously that's of concern where you may wish to contact someone or get help at the time.

Bill Walsh: OK. Thank you for that, Dr. Ahmad. Jessie, who do we have up next?

Jesse Salinas: Next question is from Jean in Missouri.

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

Jean: Yeah, my question is, you had spoken just a little bit ago, regarding the [antivirals], which, I would definitely qualify for those, but I live in a town in southeast Missouri that’s about 40,000 people, but even the pharmacists don't seem to know what I'm talking about. I've asked my doctors. They say they don't have any authority to prescribe them. And people I talk to don't know anything about it. What can we do to get this? Seems to me like a great opportunity out there so people can actually access them.

Bill Walsh: Yeah. Great question, Jean. Let's ask Dr. Mehta.

Brijesh Mehta: Yeah, it's a fantastic question. I'm sorry you're having some challenges with seeking this medication. Certainly, despite the approval by the FDA, the rollout has not been as efficient as we'd like it to be. And there've been reports that there've been surpluses of these antiviral medications, despite their availability.

And part of it is, like you said, access, and we just need to do a better job getting the message out to our health care providers, especially the gatekeepers, the primary care physicians, as well as urgent care clinics, to ensure that patients who may be potentially infected with COVID or a high-risk category that they have access to this medication.

There's also the government websites where you can look up information about where in your community these medications are currently available, and that can be provided through the CDC. And if you just simply Google “COVID antivirals,” you'll have access to some of those resources within your town.

Bill Walsh: OK. Thanks so much for that, Dr. Mehta. Jesse, who is our next caller?

Jesse Salinas: Our next question is from Martha in Minnesota.

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

Martha: Yeah. I had what was supposed to be COVID in March of 2020, and I didn't have a test or anything because it was OK. But after that I had a constellation of symptoms ranging from brain fog to my skin burning up to other kinds of neuropathies and things like that. And none of the tests that were done revealed anything. It's been two years. About a year and a half [ago] I started feeling better, and then I got what could be a flu or a cold or something. And all the symptoms came back: short of breath, fatigue, forget things, tremendous depression, anxiety. And I honestly would like to know if there's anything that's being done, or are there any advances on how to actually terminate all this constellation of symptoms?

Bill Walsh: Right. OK. Martha, thank you so much. And I hear your labored breathing there. So just take a moment, relax, and let's listen to what our experts say. Dr. Mehta, can you offer any words to help Martha and other folks in her position?

Brijesh Mehta: Hi, Martha, I'm sorry you’re experiencing these symptoms. It is certainly not uncommon, and you're not alone in what you're going through. Unfortunately, many of the patients that we have seen down here in south Florida, and what has been reported in the literature, are experiencing 30 to 40 percent long COVID symptoms, similar to the constellation of symptoms that you were describing.

And the advice is to manage each of those symptoms with either counseling, especially if it's depression, anxiety, through what Dr. Ahmad just went over, as well as if it's neuropathy issues or myalgias, any cardiac or breathing issues, to have those be evaluated accordingly, because there is no one cure that is going to address all of these.

We wish, certainly, there was, but right now it's on a symptom-by-symptom basis. And so certainly encourage you to seek the medical care, especially with the shortness of breath. And some of the neuropathy that you described, there are medications available on the market to treat those symptoms, the neuropathies, because diabetics and others afflicted, after a stroke and many times have painful tingling sensations in the arms and legs, and you would certainly benefit in that.

Bill Walsh: Hmm. I mean, Dr. Mehta, you heard her labored breathing. Should she get treatment for that right away?

Brijesh Mehta: Absolutely. if you have a pulse oximeter at home, you can certainly check that, especially when you feel very symptomatic and short of breath. That's available at your local drugstores. But if you're just not feeling like you can catch your breath, even after just a couple of steps of walking or speaking, then certainly, go to your nearest urgent care or emergency room.

Bill Walsh: Yeah. OK. Thanks, Dr. Mehta, and take care of yourself, Martha. Let's take another question, Jesse. Who's next?

Jesse Salinas: Yeah, we're going to bring on Ingrid from Illinois.

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

Ingrid: Yes. I was wondering how much outdoor activity is too much. And how can I manage damaging emotions, like anger, and how would that contribute to me getting a stroke? 'Cause I'm angry a lot of the time, and I don't want to be. How can I take steps not to feel that way?

Bill Walsh: Yeah, I hear you. Thank you, Ingrid. Dr. Ahmad, did you want to weigh in on that?

Samoon Ahmad: I could weigh in on part of the question. Absolutely. Which is, I think she's very right in the sense of the anger and emotions and this, and can they in any way weigh in, in having any physical issues? Absolutely. Because we know that people, what we call, I don't want to her to think I’m labeling, but what we call type A personalities who are very much stressed and feeling angry and very much always on the go, they are more likely to have cardiac issues.

And as I had mentioned earlier, which is the whole cycle of the stress response, fear response system in the body, which puts you in this, sort of, if you visualize this cat with their paws and hair standing up. We start up in that state of panic and anger and irritability and stress that puts our physical system at significant disadvantage of leading to many cardiovascular problems and this. So, coming back to how to de-stress, that's fundamentally apart from that if you have any physical issues, obviously you need to address those, but it's extremely important.

And as I've mentioned, the muscle relaxation techniques, or listening to music or gardening or walking or reading, or any of those activities, which can sort of disengage you from that moment in time, would be extremely helpful, or deep breathing that I'd mentioned, which is fundamentally one of the braking systems of reducing that stress would be fundamentally. But I think that's what I can contribute to that.

Bill Walsh: OK, Dr. Ahmad, thank you. And Dr. Mehta, thank you, too, for answering all of our questions. This has been a really informative discussion, and thank you, our AARP members, volunteers and listeners, for participating in our program 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 the recording of the Q&A event, can be found at aarp.org/coronavirus starting tomorrow, May 6th. 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. And if you're looking for Medicare assistance during COVID-19, please visit shiphelp.org/COVID-19. That’s shiphelp.org/COVID-19 for Medicare assistance.

We hope you learned something that can help keep you and your loved ones healthy. Please join us on June 9th for another live coronavirus Q&A event. Until then, thank you and have a good day. This concludes our call.

[00:00:00] Bill Walsh: Hello. I am AARP Vice President Bill Walsh. And I want to welcome you to this important discussion about the coronavirus. Before we begin, if you'd like to hear this telephone town hall in Spanish, please press *0 on your telephone keypad now.

[00:00:22] 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. Americans are relieved that after more than two years under the cloud of COVID-19, pre-pandemic activities are resuming and people's lives are returning to a semblance of normalcy.

[00:00:52] While we hope the worst is behind us, experts believe there could be lingering effects to our bodily health and our mental health for quite some time. They say that exercise, stress management and mental health care are more important than ever. And as we transition into this next phase of the pandemic, many people have questions around balancing safety with their desire to socialize and do the things they used to love to do.

[00:01:19] Today we'll hear from an impressive panel of experts about these issues and more. We'll also get an update from Capitol hill on legislation affecting older Americans. If you've participated in one of our Tele-Town Halls in the past, you know this is similar to a radio talk show, and you have the opportunity to ask your question live.

[00:01:38] For those of you joining on the phone, if you'd like to ask a question about the coronavirus pandemic, press *3 on your telephone to be connected with an AARP staff member who'll 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.

[00:01:58] Hello. If you're just joining, I'm Bill Walsh with AARP, and I want to welcome you to this important discussion about the global coronavirus pandemic. We're talking with leading experts and taking your questions live. To ask your question, please press *3. And if you're joining on Facebook or YouTube, you can post your question in the comments.

[00:02:18] We have some outstanding guests joining us today, including a mental health expert and neurosurgeon. 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.

[00:02:40] Again, to ask your question, please press *3 at any time on your telephone keypad to be connected with an AARP staff member, or if you're joining on Facebook or YouTube, drop your question in the comment section.

[00:02:54] Now I'd like to welcome our guest. Samoon Ahmad, M.D., is a clinical professor of psychiatry at the NYU Grossman School of Medicine. He's also the founder of the Integrative Center for Wellness. His new book is Coping with COVID-19: The Mental, Medical, and Social Consequences of the Pandemic. Welcome to the program, Dr. Ahmad.

[00:03:18] Samoon Ahmad: Thank you so much. It's a pleasure to be here.

[00:03:20] Bill Walsh: All right. It's a pleasure to have you.

[00:03:22] Brijesh Mehta, M.D., is the director of neurointerventional surgery at Memorial Neuroscience Institute in Florida. Welcome to the program, Dr. Mehta.

[00:03:32] Brijesh Mehta: Thank you very much. It's an honor to be here.

[00:03:35] Bill Walsh: All right. Thank you both for being here. And just a reminder to our listeners: To ask your question, please press *3 on your telephone keypad or drop it in the comment section on Facebook or YouTube. Let's go ahead and get started. Dr. Ahmad, a worldwide pandemic, of course, is not a typical experience of aging. How has the stress and uncertainty of the last two years affected older adults?

[00:04:04] Samoon Ahmad: Well, I would say that the stress of the pandemic has been difficult on everyone. And I would include myself in that equation. And I think it's important to express my own concerns so that it would be important for people to understand that I was working at the time at Bellevue Hospital in New York City. And I got COVID very early on. In fact, it was March of 2020, and there was so much uncertainty, no idea about what the impact would be, how to treat this condition.

[00:04:42] So it was pretty terrifying, and it was like a mystery disease at the time. And then last year, during the pandemic, I lost my father, who was in his 90s. So I can understand when you use the word “stress” and “uncertainty,” it's a [unintelligible] and it's very close to my heart and I've experienced it myself.

[00:05:03] Now, that said, I think the circumstances for seniors have been uniquely difficult, and there are numerous reasons why, but I would like to focus, I think, on the important ones, which are two. The first is that COVID-19 tends to be more severe in older individuals. So it's pretty natural that a lot of seniors need to be and are in fact more diligent when they are thinking about or planning to see friends and family. And oftentimes they do take that into consideration, that the risk of attending an event may be too high for them. So they choose — I don't know how many people are going to be there, is it a closed environment, how am I going to interact. So they choose not to go.

[00:05:49] Now, it's OK if you skip one or two events; that's not going to be a big deal. However, when you start missing major holidays, birthdays, other milestones with your family, it can lead to a feeling of loneliness and despair. And I would say that like so many other problems that arose during the pandemic, loneliness among seniors even existed well before 2020, particularly in the U.S. But you know what happened? This kind of continued isolation I'm describing is weighing particularly heavily on seniors at this point.

[00:06:26] Secondly, people over the age of 65 make up about 75 percent of all COVID-19 deaths, even though they are only around 16 percent of the population. And COVID-19 deaths have been also more common in older men than older women by a margin of around, I would say, 50,000. Now, what this means is that far more older women, particularly older women of color, have lost a spouse. And this is emotionally difficult, of course, but it's also difficult for a variety of other reasons.

[00:07:00] Bill Walsh: Doctor, you have talked about some of the emotional risks associated with COVID-19, the isolation, et cetera. I was wondering if we could also talk about another risk, and that's the unmet health needs. Of course, a lot of people put off regular appointments with their doctor because of the pandemic. They were too nervous about going into a medical environment, and health experts say it's critical that older adults resume this sort of preventative care and screenings. What are the most important preventative screenings for older adults? Dr. Ahmad, why don't you start in, and Dr. Mehta, I'll ask you as well.

[00:07:41] Samoon Ahmad: Right. So when you think about preventative screenings for older adults, their normal battery of tests that they're very accustomed to when they see their doctor. But I think you can look for certain signs and symptoms if you're looking in friends and family, or for yourself, if you're caring for someone who is significantly older. And I think it's important to think about that older adults as a single group, when you're around 60 — I myself am 60 and my father was 90. So we have very different pandemic experiences. And we should be screened for different things for those of us older, but still close to the middle age group should be screened for anxiety, for depression, prolonged grief disorders.

[00:08:22] And you don't do this just by noticing sad feelings. Rather, you may notice a lack of interest in doing things and irritability. There could be more increased alcohol consumption or drastic changes in weight or sleep patterns. Now, for people who are closer to my father and that age group, the symptomatology can be a little different, and you should always look for things like changes in weight and declining interest.

[00:08:52] But the important thing is, in that age group, cognitive problems are a major symptom of, particularly, depression in people of advanced age. And whereas the symptom is rarely observed in younger individuals. In fact, within the field of psychiatry, we call it pseudodementia. And it almost mimics that picture, and patients seem to be losing their cognitive and intellectual faculties, but when you treat them for depression, suddenly the symptoms disappear, which actually tells you that, no, this is not something that's an organic cause for dementia or anything. These are just symptoms that mimic. And that's a very important one, because spouses can notice — the grandchildren, children or anybody can — something is going off that you're having a difficult time remembering things or where the misplaced things are, or they're not tending to their bills on time, any of those things. So it depends upon what age group, but that's one way to do preventive screening.

[00:09:48] Bill Walsh: Thanks so much, Dr. Mehta. Did you want to add to that list? Preventative screenings that people should be doing at this point?

[00:09:56] Brijesh Mehta: Yes. So I agree with Dr. Ahmad that, especially during the pandemic with the social isolation, mental health is certainly at the forefront right now. And especially if a patient's, individuals, had pre-existing conditions, that, studies have shown, has been exacerbated over the past two years.

[00:10:19] And so it's certainly resuming, through preventative services, some of the screening, for cognitive issues, anxiety, depression, like you said, is paramount. And from a cardiovascular, cerebrovascular standpoint, it's also important as patients, population in general, becomes more comfortable going back to the hospital, back to the clinic to be seen by their primary care provider, to be screened for risk factors for diabetes or high blood pressure, hyperlipidemia, meaning high cholesterol, as well as smoking counseling, particularly if they tended to increase or worsen their smoking habits during the pandemic. Any of these conditions and addictions should require some form of counseling and preventative care, including medication compliance.

[00:11:17] Bill Walsh: Yeah, thanks so much for that. Let me follow up. Dr. Mehta, according to the Journal of the American Medical Association, the incidence of heart attacks and strokes had been declining prior to the pandemic, but now has reversed course, with exaggerated differences among minority populations. Why are we seeing so many heart issues related to the pandemic, and why are Black and brown populations facing a higher risk?

[00:11:44] Brijesh Mehta: That's a great question. In the state of Florida, where I practice, through the Florida Stroke Registry and similar consortiums, we've looked at health care disparities, especially within the minority populations, and what we have learned is that it’s multifactorial. There are reasons behind it that should be addressed through epidemiological measures, such as overall access to preventive services that we just discussed, as well as financial ability to afford going to the doctor, paying for medications and, specifically for stroke, secondary stroke prevention is very important.

[00:12:31] We have noticed, especially in the last two and a half years over the pandemic, that after a patient suffered in initial TIA or an actual stroke, that their compliance and ability to follow up on a regular basis and where we could ensure that they were on the appropriate medications, that trended down.

[00:12:53] And there's also, especially among African Americans and other minority populations, I think there has been, unfortunately, a baseline mistrust of the health care system, and especially of authority figures, and that has been reported over the last several years, and something that we, as medical authorities, health care institutions are actively working on trying to reassure them that we are in the interest of treating their health, their families, and that we mean the best for thei, chronic illnesses.

[00:13:31] Bill Walsh: Well, let me talk about some of the other complications related to COVID. Of course, the CDC recently reported that 60 percent of the U.S. population had been infected with COVID-19 at some point. Now, complications from COVID-19, even in mild cases, have included things like blood clots, heart disease, stroke, as you were just saying, and diabetes. What are the long-term risks, Dr. Mehta, if you've had COVID?

[00:14:01] Brijesh Mehta: Yeah, so we're continuously learning more about the fact of long COVID, if you will, and what are the various multisystems that it could span and affect. And, particularly in my specialty, in neuroscience neurosurgery, what we have seen as lingering effects of COVID and, even in folks who initially may have been asymptomatic, is, as Dr. Ahmad alluded to earlier, depression, anxiety, just generalized fatigue, malaise, some of these symptoms we've seen in about 30 to 40 percent of our COVID-infected patients. And the etiology as to why we're seeing it in this population, weeks and months out after an initial infection, we're still learning, but it has something to do with persistent, ongoing autoimmune response and inflammation within the blood vessels.

[00:15:04] Particularly at the height of the pandemic, similar to what scientists noticed in the Northeast, we also saw in Florida the increased risk of stroke among patients who were suffering from COVID. And unfortunately, those patients, despite acute intervention, had worse outcomes, inability to open up those arteries due to clotting disorders as a result of COVID.

[00:15:29] Bill Walsh: Well, let me follow up on that. You mentioned stroke. I'm wondering if you could quickly share the warning signs that should prompt someone to contact their physician if they feel they might've had a stroke or maybe they've seen a loved one who is suffering some of those symptoms.

[00:15:47] Brijesh Mehta: Sure, absolutely. May being stroke awareness month, we're doing everything possible in our local community and beyond to educate the patients and those at risk about stroke signs and symptoms. So, the acronym that we use, and it's been championed by the American Stroke and Heart Association, is called BE FAST. So, Balance, Eyes, Face, Arm, Speech and Time. So, if an individual has sudden onset of difficulty with their walking, maintaining their balance, trouble seeing — all of a sudden there's a field cut within their vision or double vision — difficulty with their facial expressions. And it's usually the loved ones that pick up on some of these subtle clues, such as facial droop, asymmetry of their face. And let's say they're holding a pen or a cup of coffee, and all of a sudden they have weakness in that arm or hand or difficulty getting words out, which is the speech part. Essentially, time is of essence.

[00:16:52] And we encourage family or individuals that may be suffering the signs or symptoms to call 911 immediately, as every minute that lapses after onset of stroke-like symptoms, about 2 million neurons are at risk for permanent damage. So the faster they seek care, the better the potential outcome.

[00:17:12] Bill Walsh: OK, thanks so much for that, Dr. Mehta. Now, we've been talking about some of the physical complications associated with COVID-19. Let me talk about some of the mental health issues. In a recent AARP survey, we found that more than 30 percent of older adults have been bothered by anxiety, have had little interest or pleasure in doing things, and have experienced feelings of depression or hopelessness. Four in 10 say they aren't able to easily bounce back from hardship. Dr. Ahmad, where do older adults turn for help if they're having feelings of hopelessness, loss or depression?

[00:17:51] Samoon Ahmad: Well, I think the first place, in my opinion, they should turn to when at the same time it should be reciprocated by, is the families. But particularly, I would say among younger people at this point there is far less stigma about problems with mental health, and the pandemic has even made it more socially acceptable to have this conversation.

[00:18:11] So, talk to children, talk to grandchildren. They are going to be far more empathetic than we think they are. And if you don't feel comfortable talking to the family, or you think that you need help from a mental health professional, licensed therapists are trained to help people struggling with depression, anxiety or a general sense of malaise, while specially trained grief counselors can help those who have lost someone close to them.

[00:18:37] I would first suggest to talk to the primary care physician and ask for recommendations. And if you want to explore, then, other options, ask neighbors, associates and friends whom you trust, and if you are more of a religious person, I would recommend speaking to the leader of your congregation. They often have a very strong background in counseling and offer comfort to those who feel rudderless or lost. And they can also recommend, in fact, a mental health professional for you. Finally, I think things like stress levels, the amount of sunlight you get, how many hours you sleep and diet can really impact your mood.

[00:19:16] In fact, there was a review and analysis that showed that in an enormous amount of data, about 2 million person year, found that people who got a moderate amount of exercise, which is equivalent to about two and a half hours per week of just brisk walking, were far less likely to be depressed. And I think it's important to think that a lot of people like to compartmentalize their body and mind, but the two are intimately connected, and you can end up feeling quite oppressed and depressed by negative feelings if you're not living a healthy lifestyle. So, therefore, I would consider, in fact, joining some sort of either a senior center or other place. And when exercise I don't want people to get the impression I'm talking about something hard and tiring. No, I'm just talking about normal physical activity, brisk walking, gardening, going for some cycling, taking a cooking class or healthier meals. You just need about 30, 40 minutes just to sort of go out and do things. But that would be one way to start. I would say to start, whether it's your neighbor or your friend or a family or a PCP who can recommend and be someone who can make that referral for you.

[00:20:32] Bill Walsh: OK. As a reminder to our listeners, if you'd like to join the conversation and ask your question live, press *3 on your telephone keypad at any time. And if you're on Facebook or YouTube, just drop your question into the comment section.

[00:20:49] Now, Dr. Ahmad, sometimes mental health treatment is stigmatized as if it were a sign of weakness. Have we seen improvements related to that during the pandemic, and how can trust and awareness be established, particularly with ethnic communities where there is a great deal of distrust?

[00:21:08] Samoon Ahmad: Well, I think number one, there's no question that compared to where we were and where we are at this point, there has been a sea change at this point compared to what existed before. So I think I would say that people are seeking a lot more help at this point. People are talking about, they bring up many times physical symptoms, and once you start talking about physical symptoms — I try to sort of make that connection between the mental and the physical and the reciprocal relationships between the two — people are lot more open. And there is a sea change in terms of virtual health care, which is also available at this time. Now, it doesn't in any way substitute for actual in-person meeting. But people are a lot more willing to sort of sit in the comfort of their home, because they are concerned about going out or being with another person, the risk. So from that perspective as well, people are a lot more open in terms of being able to seek help.

[00:22:20] Bill Walsh: Great, well, that's great news. And thanks for that update, Dr. Ahmad. Let's talk a little bit about resources that people can use. This is a very important discussion, given that May is mental health awareness month. I wanted to remind them that AARP has some excellent free mental health tips and tools and resources that can be found on our Mental Health Resource Center. That address is www.aarp.org/mentalhealth, all one word, so www.aarp.org/mentalhealth. Or if you're feeling isolated, in need of a friendly voice, please call AARP's Friendly Voice toll-free line at 888-281-0145. That's 888-281-0145. Once again, that's a free service in English and in Spanish. And as a reminder to our listeners, to ask your question of our experts today, please press *3 at any time on your telephone key. Or drop your questions in the comment section of Facebook or YouTube.

[00:23:35] We're going to take those live questions soon. But before we do, I wanted to bring in Megan O'Reilly. Megan is the vice president at AARP for health and Family. And she's going to be updating our listeners about how AARP is fighting for them. Welcome to the program, Megan.

[00:23:52] Megan O'Reilly: Happy to be here, Bill.

[00:23:54] Bill Walsh: All right. What's the latest news on the advocacy front?

[00:23:58] Megan O'Reilly: AARP’s top priority continues to be our fight to lower prescription drug prices for older Americans. Recent polling shows this is the number one health issue voters want Congress to tackle this year. And it's our number one issue, too. For years, Congress has promised to address the skyrocketing price of prescription drugs. And we're finally on the cusp of seeing change. We've never been this close to major prescription drug reform, and it needs to pass now.

[00:24:27] Bill Walsh: OK. Well, what kinds of prescription drug reforms are we pushing for?

[00:24:32] Megan O'Reilly: Above all else, we want Medicare to be allowed to negotiate for lower drug prices. We also want to put a cap on out-of-pocket costs for older adults for what they're paying for their prescription drugs. We want to see penalties imposed on drug companies that raise their prices faster than the rate of inflation.

[00:24:50] Seniors are sick and tired of paying the highest prices in the world for their medicines. And they want relief. In fact, we know more than 80 percent of voters across parties support these reforms that would help families afford medications and save taxpayers billions of dollars each year.

[00:25:06] Bill Walsh: OK. Now, just this week, AARP also endorsed legislation expanding at-home care for veterans. What can you tell us about that?

[00:25:16] Megan O'Reilly: Absolutely. AARP endorsed the Elizabeth Dole Home and Community-Based Services for Veterans and Caregivers Act of 2022. This legislation would expand access to and improve coordination between VA programs. And it would also improve support for veterans and their family caregivers.

[00:25:35] Bill Walsh: Now, why is that so important, Megan?

[00:25:39] Megan O'Reilly: Veterans should be able to remain living in their homes for as long as possible. And this legislation would help them do that. After serving our country, these men and women deserve to live with independence, security and dignity. AARP is fighting for all veterans to have high-quality affordable options when it comes to long-term care, especially their care at home.

[00:26:00] Bill Walsh: OK. Now, finally, if our listeners want to stay on top of AARP’s advocacy news, how can they find out the latest updates?

[00:26:10] Megan O'Reilly: It is so important to stay on top of the issues affecting you and everyone age 50 and older. We would encourage you to go online and search “AARP Fighting for You. That will point you to a daily roundup of the latest advocacy, news and updates. It's a great way to stay informed, and we encourage everyone to check it out.

[00:26:29] Bill Walsh: OK, great. So search AARP Fighting for You. Got it. Thanks so much, Megan, for being with us today.

[00:26:38] Megan O'Reilly: Thank you, Bill.

[00:26:39] Bill Walsh: All right. And as a reminder to our listeners, press *3 at any time on your telephone keypad to ask your question to our mental health expert and our neurosurgeon who are on the line and waiting to answer those questions today. It's now time to address those questions with Dr. Samoon Ahmad and Dr. Brijesh Mehta. As I said, press *3 at any time on your telephone keypad to be connected with an AARP staff member to get into the queue to ask your question live. And if you'd like to listen in Spanish, press *0 on your telephone keypad now.

[00:27:19] All right. Now I'd like to bring in my AARP colleague Jesse Salinas to help facilitate your calls today. Welcome, Jesse.

[00:27:26] Jesse Salinas: Thanks so much for having me today, Bill.

[00:27:28] Bill Walsh: All right, who do we have first?

[00:27:31] Jesse Salinas: Our first question is going to come from YouTube. This is from Craig in Oklahoma, and his question is: My family has a history of stroke. Am I at a higher risk due to COVID, or what should I do to protect myself?

[00:27:44] Bill Walsh: That sounds like a great question for Dr. Mehta. Dr. Mehta, can you answer that one for us?

[00:27:49] Brijesh Mehta: Yeah, that's a great question. So, if a person has a family history of a stroke, whether it's due to blockage of an artery in the brain or due to bleeding in the brain, those are both considered the various subtypes of strokes. And it's important when they are evaluated by a neurologist, ideally, a stroke neurologist, or their primary care doctor, that some of those risk factors for why their family members had strokes are clearly identified, such as preventable issues like high cholesterol, high blood pressure, diabetes, smoking. And if any of the patients or family members have similar risk factors, then that is the right time to get those under control, either through lifestyle modifications and or exercise and medication compliance.

[00:28:43] And if despite those kinds of interventions, it's still difficult, sometimes genetics does play a significant role. Then it's important to be on the right medications and also undergo some additional workup, given the various etiologies, causes, of strokes, such as blood clotting, to make sure we identify those, especially at a young age, so that you can live a long, healthy life. COVID, we know, certainly increases the risk of stroke regardless of family history and so forth. And when patients have COVID, unfortunately, it's not fully understood why some patients experience blood clotting issues and others don’t, but once it's identified, it's important to be on blood thinners and also to make sure that any underlying health care conditions, such as diabetes, obesity or high blood pressure, are modified as much as possible.

[00:29:50] Bill Walsh: All right. Dr. Mehta, thanks so much for that. Jesse, who do we have up next?

[00:29:55] Jesse Salinas: Our next question is going to be from Ted in Nevada.

[00:29:59] Bill Walsh: Hey, Ted. Welcome to our program. Go ahead with your question.

[00:30:09] Ted: I wonder about how much sleep do I need. I have all the symptoms. Is more sleep helpful?

[00:30:21] Bill Walsh: Is more sleep helpful for preventing COVID or treating COVID or, is that your question?

[00:30:27] Jesse Salinas: I think that's it.

[00:30:28] Bill Walsh: All right. OK. Dr. Ahmad, I wonder if you can talk about the importance of sleep, the need for sleep and maybe it's someone recovering from COVID.

[00:30:40] Samoon Ahmad: Right. So, I think in some ways the caller hit the nail on the head, that sleep is one of the most fundamental, essential needs. And, in fact, many people who struggle with depression, anxiety, one of the main things that is a comorbidity is sleep problems in those patients. And sleep by itself obviously is just a symptom of an underlying condition, and people who don't sleep well or have difficulty, apart from being about anxiety and depression, I want to emphasize, and Dr. Mehta, I can explain more, but those people lead to more stress. It leads to more stress. And stress, in fact, then leads to this cascade, of all kinds of various hormones and neurotransmitters that predispose an individual over a prolonged period of time to many of the chronic ailments, including heart attacks or high blood sugar or diabetes or obesity or inflammation in the body, which also causes neuroinflammation, which then can predispose you to not only psychiatric conditions, anxiety, depression, but many other conditions which may have to do with cognitive disorders, Parkinson's disease and others.

[00:31:56] So addressing sleep is essential, both psychologically as well as mentally, because to think of anything that's happening in your mind as if it stays above the neck, things that happen above the head — it's not like Vegas, what stays in Vegas. It has reciprocal relationships throughout the body, and it's essential to actually address those. So people that have chronic ailments will have sleep problems without a question. And if one is obese or you have more weight, sleep apnea can sometimes actually predispose you and you have more risk of hypertension in that. So people with mental illness or other conditions can have sleep problems. People that have many physical ailments, they'll have sleep issues. And then they reciprocate and have issues in terms of all of the chronic ailments that I just mentioned.

[00:32:49] Bill Walsh: OK. Thanks so much, Dr. Ahmad for that. Jesse, who is our next caller?

[00:32:55] Jesse Salinas: Our next caller comes from YouTube. L.M. asks: Since the COVID pandemic, my anxiety has increased. What are some tips to cope with that type of anxiety?

[00:33:06] Bill Walsh: Dr. Ahmad, you seem suited to answer this question. Too.

[00:33:08] Samoon Ahmad: Yup. So, you're absolutely right. I mean, usually the baseline prevalence of an idea is about 7 percent, 8 percent. Now it's happening at 39 to 40 percent, and the symptoms of anxiety, most of the times people are experiencing, which is natural at this point. But I think some of the coping strategies that people can incorporate into their life, I specifically talk about breathing exercises.

[00:33:38] People tend to just sort of disregard the importance of breathing, and the reason I'm bringing up the issue of breathing is because breathing increases sort of what we think about in the body is the braking system of the body. It sort of slows our heart rate. It reduces the stress overall. So taking time, I would say about 10 to 15 minutes, three times a day, what we call it, the dominant breathing, for example, which is you sit down in an upright position and you inhale as much as you can deeply, try to hold your breath and then exhale for twice as long as your inhalation. Try to visualize a scenic or a beautiful place that usually you like to go and visit and try to do this. That's one way to manage.

[00:34:28] The second would be what we call a muscle relaxation technique. And the idea is, again, to sort of sit in an upright posture and think of from your toes all the way up to your neck, you are putting your muscles into extreme contraction, holding them for a little period of time, and then sort of let them go suddenly. And then that's release, but apart from that, there are other things, where doing things outside, physical activity. That's one way to mitigate stress as well. Meditation, yoga. Those are some of the other strategies that you may want to think about. So I think lifestyle changes overall are an extremely important element of reducing anxiety.

[00:35:14] Besides the fact that you may want to talk to someone or seek help, or in cases where it's to the point where you are having difficulty functioning personally, professionally, you may need to seek professional help for some other medical treatments.

[00:35:28] Bill Walsh: OK. Thanks so much for that, Dr. Mehta. Jesse, let's take another question.

[00:35:33] Jesse Salinas: Yep. Our next question comes from Sue in New York.

[00:35:36] Bill Walsh: Hey, Sue. Welcome to our program. Go ahead with your question.

[00:35:42] Sue: I have a cardiologist who just wants to do a routine stress test, and they wanted me to take the medication one. And I said, no, that's crazy. 'Cause I have a bad knee, but I think I could do the other one. But the point is I don't want to go into the hospital and have this done. And there's no reason for it.

[00:35:59] I do not have any preexisting conditions. I mean, I have GERD and hiatal hernia and fibromyalgia and hypothyroidism. I don't have any heart conditions. Now, my dad did die of a stroke at the age of 70 and I am 72, but I don't want to take the risk because COVID is very high here. Why would he be asking for this?

[00:36:20] If, I think, I took an electrocardiogram, and it was fine and there were no problems. He said that. Why do people have to have a routine stress test? Is it something you have to have at a certain age? And why would I want to do that now?

[00:36:36] Bill Walsh: All right. Well, let's ask Dr. Mehta. Dr. Mehta, can you help Sue?

[00:36:41] Brijesh Mehta: Hi, Sue. That's a good question. And it’s certainly worth questioning the indication for a cardiac stress test. Unless you're having some ongoing symptoms, such as chest pain during exercise or even during daily activities such as walking, working around the house, I do not, from what you have described, see a strong indication to undergo a cardiac stress test. It is not part of the routine U.S. [Preventive Services] Task Force guidelines for older individuals, i.e., those above 65 years of age, to undergo cardiac stress tests, unless you're having any of the symptoms, such as chest pain and shortness of breath on exertion, meaning with routine activities. …

[00:37:36] As far as concerns about going into the hospital, because of COVID surges, I certainly sympathize with that concern. You know what, I can reassure you just from a health care institution standpoint, any facility that is managing patients in the United States has undergone extensive training, and safety protocols are in place to make sure that patients, when they come in for any other medical problems management, that they're kept safe. And all the staff are trained to keep those environments separate from the COVID units and also have the appropriate PPE on hand. So just wanted to reassure you about that.

[00:38:26] Bill Walsh: OK. Thank you for that, Dr. Mehta, and thanks for all those questions, we're going to be taking more of your questions. And as a reminder, if you'd like to get in the queue and ask your question live, press *3 on your telephone keypad at any time.

[00:38:40] Dr. Ahmad, I wanted to get back to you. We've seen in recent years increasing options for online or virtual mental health, done remotely through your computer or a tablet. Is virtual mental health able to replicate the in-person treatment? Is it effective?

[00:38:59] Samoon Ahmad: The short answer, no. But I would say talk therapy, which is [the] most common use of telehealth and is largely based on verbal communication, therapists are able to put together a lot of information. But I would say if you are trying to assess in terms of some of the symptomatology that we like to see, for example, a person who is sitting complaining of anxiety, but you see they’re literally trembling, shaky, you really can't assess such things while you are on a telehealth platform. In person, as human beings being social animals, we like to connect with people more in person, though, the visual cues being in close proximity to another person, getting their facial expressions in person rather than on a Zoom or FaceTime, two very different ways of communicating. So I think during the last two years, obviously, because of the concerns, I think it did a great service. There's no question about it. It was … patients were able to get significant help. So I am not in any way minimizing that, but I would say that if there is a choice and if people are able to manage, I would still suggest in-person treatment at this point.

[00:40:26] Bill Walsh: OK, thanks for that. And let me quickly follow up. I wonder about the cost considerations. Is mental health telemedicine covered by private insurance or Medicare?

[00:40:39] Samoon Ahmad: Well, there for a time, yes. Then there was a sort of question came into being that we need to stop that, but by some patient advocacy and a lot of support and people still being quite concerned about it, most insurances, even Medicare, are covering partially or to a significant extent the use of telehealth medicine. But to go into the private insurances, it varies across, for example, at one point across state lines, people who are allowed to use, and that's becoming a little bit more limited. At one point it was completely expanded so that people could get adequate help. So there are a lot of variables, but it's difficult to answer question in purely yes-and-no form, but yes, in the way the system is right now, Medicare does cover. To a certain extent, so do private insurances.

[00:41:33] Bill Walsh: OK. Thanks for that. Dr. Mehta, let me turn back to you. Last year, the FDA approved powerful COVID antiviral drugs, and we're now seeing an increase in production and availability. What are antivirals, and why do they matter?

[00:41:50] Brijesh Mehta: Bill, that's a good question. So antivirals, they have been around for a good part of the last 50, 60 years. And they work, basically, by binding to receptors within the cells of our body that may be infected with the virus, and they prevent the virus from replicating within those cells. And most of the antivirals on the market, some of our listeners will be familiar with, for example, the influenza antiviral medication Tamiflu. And now with COVID, as you mentioned, there’s been approval by the FDA of the Pfizer antiviral is called Paxlovid.

[00:42:39] And basically the goal is to prevent any worsening of COVID symptoms into more severe disease that kind of affect our lungs, heart and, as we have discussed, other parts of our body, including the brain. The key thing is to take it within the first few days of symptom onset. And keep in mind, this is not approved for any and all patients that become infected with COVID. It’s for those who are at particularly high risk. That category is defined as those adults 65 and older, and those with certain underlying health conditions, such as heart disease, cancer, diabetes or obesity. And so it's not a substitute for getting vaccinated. This is for patients who are in that high-risk category and get afflicted with COVID. It can certainly prevent some of the downstream sequela.

[00:43:44] Bill Walsh: Now, let me ask you, at this moment in time, it seems like COVID is abating, hospitalizations are down, et cetera. For people who did not receive a vaccine, or they couldn't get a vaccine because the systems were compromised for some other reason, how do they manage social activities and exercise now? What advice would you give them at this point in the pandemic?

[00:44:13] Brijesh Mehta: Right. I think it’s important to emphasize to those individuals that just like during the worst surges of the pandemic, that this still comes down to our individual responsibility. That while we may be out of the worst part of the pandemic in terms of caseloads and overwhelming the health care systems, it comes down to making sure that we still continue to mask, especially in highly concentrated areas, social gatherings. And particularly if you're experiencing symptoms to exercise that responsibility, to ensure that you follow the CDC guidelines for quarantine, especially in the first few days after symptom onset, and practice that social distancing. And wearing a mask is still very helpful and the most effective preventative measure in terms of protecting our loved ones in the community.

[00:45:18] Bill Walsh: Now, of course, we've seen so many masks come off in recent weeks. If you're the only person in the room wearing a mask, is there any benefit?

[00:45:28] Brijesh Mehta: Certainly, we've all been in situations where, depending on our kind of individual comfort level, as well as uncertainty about who may or may not be symptomatic, and we make that personal choice to wear a mask. It’s still very helpful because a mask, as data has shown, can reduce the overall inhalation of these aerosol droplets, which is how COVID is transmitted, by 50 to 70 percent.

[00:46:04] And so having a multilayer cloth mask, even if you’re the only one in the room wearing it, you're essentially protecting yourself as well as, when you're talking or just in part of normal conversation, if you're experiencing symptoms and unknowingly may be infected with COVID, you’re also protecting others from catching it.

[00:46:28] Bill Walsh: Right. OK. And last question for you, Dr. Mehta, I wonder, can COVID directly harm the brain? A recent study in the Journal of Psychiatric Research found that some folks have become more forgetful and slower to process information following COVID. Is this COVID fog long COVID or something else? And what's the cause? What should people know about that?

[00:46:51] Brijesh Mehta: That's a great question. And I'm sure Dr. Ahmad can add to this as well. What we have seen in our neuro follow-up clinics, especially those after a stroke that we tend to see who may have been infected simultaneously with COVID at the time of initial admission, we're seeing and hearing from our community neurologist that these patients are presenting with cognitive issues like you said, forgetfulness, difficulty performing the simplest activities of daily living that we all take for granted, balancing checkbooks, tasks around the house. And we are in the process now of still learning more, as part of national studies, but it is certainly something that, as we were discussing earlier, has to do with ongoing inflammatory response that damages the neurons in the brain and that persistent sort of autoimmune response is what's causing these long-term effects, and it's not something to take lightly. And we're logging these patients in our clinic as part of our screening to see who is still being afflicted with these long-term symptoms and continue to learn from it.

[00:48:17] Bill Walsh: OK. Thanks so much. Dr. Ahmad, I don't know if you wanted to weigh in on, on the notion of a COVID fog.

[00:48:24] Samoon Ahmad: Right. I completely agree with Dr. Mehta. I would just expand what he just mentioned, the word inflammation, neuroinflammation, because you would think about it, from even purely cognitive effect, somebody who's unable to do what they were so used to be doing all the time or for a protracted period, now they're seeing their life sort of become so limited. Thinking about that in itself is going to make you feel very anxious and depressed that you are not able to do [what] you were once [able to] in life and professionally, personally, it [impacts] you. Secondly, inflammation, as I mentioned, the neuroinflammation, and we now understand anxiety, depression are not just figments of the imagination, this neuroinflammation underneath is responsible for these disorders.

[00:49:09] So how, as Dr. Mehta expanded, microclots in the brain and inflammation that's happening, one can think of that maybe there are some underlying, predisposing factors, which lead to this anxiety and depressive symptoms as well. So it's sort of a back and forth, I think, between those two. That's the paradigm, I would suggest, that one affects the other.

[00:49:33] Bill Walsh: Sure. That's a great observation. Thanks to you both. Now it's time to address more of our listener questions with Dr. Samoon Ahmad and Dr. Brijesh Mehta. Please press *3 at any time on your telephone keypad to be connected with an AARP staff member to get in the queue to ask your question live. Jesse, who do we have next on the line?

[00:49:55] Jesse Salinas: Yeah, our next question comes from Facebook. It's Lisa in Virginia, and she says: What can I do for my loved one who is showing signs of depression but seems to be in complete denial about it?

[00:50:05] Bill Walsh: Dr. Ahmad, what would you say?

[00:50:08] Samoon Ahmad: I would say not unusual. And people tend to feel and, very common, that somehow it's a weakness of my character, weakness of my personality. I can beat this. I don't need any help. And I think the most important thing is to just show your presence and show your love, show your affection and be a listening person or that your shoulder anybody can cry on, that constant presence. And just being around to offer help, not in a technical or professional way, but just chatting up and starting some conversations, making another person feel comfortable. That in itself can be at times where people don't feel judged. People don't feel that you are forcing them into a particular situation. And sometimes it's even helpful to share a personal vignette or a story as to what, how you have struggled in life at some point during the conversation and how you have dealt with it and how difficult it was for yourself and how you overcame that. And so the other person doesn't feel singled out, doesn't feel criticized, doesn't see that they are unique and the only one struggling and suffering in this. And that kind of open-ended engagement and conversation can be very helpful for the person, unless you find that that person is incapable of tending to the needs or is exhibiting symptoms that may be sort of potentially dangerous, any suicidal thoughts or anything, then obviously that's of concern where you may wish to contact someone or get help at the time.

[00:51:52] Bill Walsh: OK. Thank you for that, Dr. Ahmad. Jessie, who do we have up next?

[00:51:57] Jesse Salinas: Next question is from Jean in Missouri.

[00:52:09] Bill Walsh: Jean, welcome to our program. Go ahead with your question.

[00:52:13] Jean: Yeah, my question is, you had spoken just a little bit ago, regarding the [antivirals] , which, I would definitely qualify for those, but I live in a town in southeast Missouri that’s about 40,000 people, but even the pharmacists don't seem to know what I'm talking about. I've asked my doctors. They say they don't have any authority to prescribe them. And people I talk to don't know anything about it. What can we do to get this? Seems to me like a great opportunity out there so people can actually access them.

[00:52:51] Bill Walsh: Yeah. Great question, Jean. Let's ask Dr. Mehta.

[00:52:55] Brijesh Mehta: Yeah, it's a fantastic question. I'm sorry you're having some challenges with seeking this medication. Certainly, despite the approval by the FDA, the rollout has not been as efficient as we'd like it to be. And there've been reports that there've been surpluses of these antiviral medications, despite their availability.

[00:53:21] And part of it is, like you said, access, and we just need to do a better job getting the message out to our health care providers, especially the gatekeepers, the primary care physicians, as well as urgent care clinics, to ensure that patients who may be potentially infected with COVID or a high-risk category that they have access to this medication.

[00:53:47] There's also the government websites where you can look up information about where in your community these medications are currently available, and that can be provided through the CDC. And if you just simply Google “COVID antivirals,” you'll have access to some of those resources within your town.

[00:54:09] Bill Walsh: OK. Thanks so much for that, Dr. Mehta. Jesse, who is our next caller?

[00:54:14] Jesse Salinas: Our next question is from Martha in Minnesota.

[00:54:17] Bill Walsh: Hey, Martha, welcome to our program. Go ahead with your question.

[00:54:28] Martha: Yeah. I had what was supposed to be COVID in March of 2020, and I didn't have a test or anything because it was OK. But after that I had a constellation of symptoms ranging from brain fog to my skin burning up to other kinds of neuropathies and things like that. And none of the tests that were done revealed anything. It's been two years. About a year and a half [ago] I started feeling better, and then I got what could be a flu or a cold or something. And all the symptoms came back: short of breath, fatigue, forget things, tremendous depression, anxiety. And I honestly would like to know if there's anything that's being done, or are there any advances on how to actually terminate all this constellation of symptoms?

[00:55:51] Bill Walsh: Right. OK. Martha, thank you so much. And I hear your labored breathing there. So just take a moment, relax, and let's listen to what our experts say. Dr. Mehta, can you offer any words to help Martha and other folks in her position?

[00:56:08] Brijesh Mehta: Hi, Martha, I'm sorry you’re experiencing these symptoms. It is certainly not uncommon, and you're not alone in what you're going through. Unfortunately, many of the patients that we have seen down here in south Florida, and what has been reported in the literature, are experiencing 30 to 40 percent long COVID symptoms, similar to the constellation of symptoms that you were describing.

[00:56:38] And the advice is to manage each of those symptoms with either counseling, especially if it's depression, anxiety, through what Dr. Ahmad just went over, as well as if it's neuropathy issues or myalgias, any cardiac or breathing issues, to have those be evaluated accordingly, because there is no one cure that is going to address all of these.

[00:57:12] We wish, certainly, there was, but right now it's on a symptom-by-symptom basis. And so certainly encourage you to seek the medical care, especially with the shortness of breath. And some of the neuropathy that you described, there are medications available on the market to treat those symptoms, the neuropathies, because diabetics and others afflicted, after a stroke and many times have painful tingling sensations in the arms and legs, and you would certainly benefit in that.

[00:57:48] Bill Walsh: Hmm. I mean, Dr. Mehta, you heard her labored breathing. Should she get treatment for that right away?

[00:57:56] Brijesh Mehta: Absolutely. if you have a pulse oximeter at home, you can certainly check that, especially when you feel very symptomatic and short of breath. That's available at your local drugstores. But if you're just not feeling like you can catch your breath, even after just a couple of steps of walking or speaking, then certainly, go to your nearest urgent care or emergency room.

[00:58:21] Bill Walsh: Yeah. OK. Thanks, Dr. Mehta, and take care of yourself, Martha. Let's take another question, Jesse. Who's next?

[00:58:29] Jesse Salinas: Yeah, we're going to bring on Ingrid from Illinois.

[00:58:32] Bill Walsh: Hey, Ingrid. Welcome to our program. Go ahead with your question.

[00:58:36] Ingrid: Yes. I was wondering how much outdoor activity is too much. And how can I manage damaging emotions, like anger, and how would that contribute to me getting a stroke? 'Cause I'm angry a lot of the time, and I don't want to be. How can I take steps not to feel that way?

[00:59:00] Bill Walsh: Yeah, I hear you. Thank you, Ingrid. Dr. Ahmad, did you want to weigh in on that?

[00:59:04] Samoon Ahmad: I could weigh in on part of the question. Absolutely. Which is, I think she's very right in the sense of the anger and emotions and this, and can they in any way weigh in, in having any physical issues? Absolutely. Because we know that people, what we call, I don't want to her to think I’m labeling, but what we call type A personalities who are very much stressed and feeling angry and very much always on the go, they are more likely to have cardiac issues.

[00:59:33] And as I had mentioned earlier, which is the whole cycle of the stress response, fear response system in the body, which puts you in this, sort of, if you visualize this cat with their paws and hair standing up. We start up in that state of panic and anger and irritability and stress that puts our physical system at significant disadvantage of leading to many cardiovascular problems and this. So, coming back to how to de-stress, that's fundamentally apart from that if you have any physical issues, obviously you need to address those, but it's extremely important.

[01:00:09] And as I've mentioned, the muscle relaxation techniques, or listening to music or gardening or walking or reading, or any of those activities, which can sort of disengage you from that moment in time, would be extremely helpful, or deep breathing that I'd mentioned, which is fundamentally one of the braking systems of reducing that stress would be fundamentally. But I think that's what I can contribute to that.

[01:00:35] Bill Walsh: OK, Dr. Ahmad, thank you. And Dr. Mehta, thank you, too, for answering all of our questions. This has been a really informative discussion, and thank you, our AARP members, volunteers and listeners, for participating in our program today.

[01:00:50] 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.

[01:01:11] All of the resources referenced today, including the recording of the Q&A event, can be found at aarp.org/coronavirus starting tomorrow, May 6th. 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. And if you're looking for Medicare assistance during COVID-19, please visit shiphelp.org/COVID-19. That’s shiphelp.org/COVID-19 for Medicare assistance.

[01:01:56] We hope you learned something that can help keep you and your loved ones healthy. Please join us on June 9th for another live coronavirus Q&A event. Until then, thank you and have a good day. This concludes our call.

Teleasamblea de AARP

Coronavirus: la vida más allá de la pandemia

 

 

Participan:

 

Samoon Ahmad, M.D.: profesor clínico de Psiquiatría, Facultad de Medicina Grossmand de NYU. Fundador, Integrative Center for Wellness

 

Brijesh Mehta, M.D.: director, Cirugía Neurointervencionista, Memorial Neuroscience Institute

 

Megan O'Reilly: invitada especial, vicepresidenta, AARP

 

Jesse Salinas: organizador, vicepresidente, AARP

 

Bill Walsh: moderador, vicepresidente, AARP

 

 

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

 

[En español]

 

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

 

Los adultos se sienten aliviados de que después de más de dos años bajo la nube de COVID-19, las actividades previas a la pandemia se están reanudando en la vida de las personas, volviendo a una apariencia de normalidad. Si bien esperamos que lo peor haya quedado atrás, los expertos creen que podría haber efectos residuales en nuestra salud física y mental durante bastante tiempo.

 

Dicen que el ejercicio, el manejo del estrés y el cuidado de la salud mental son más importantes que nunca. Y a medida que hacemos la transición a la siguiente fase de la pandemia, muchas personas tienen preguntas sobre cómo equilibrar la seguridad con su deseo de socializar y hacer las cosas que aún les encanta hacer.

 

Hoy escucharemos a un impresionante panel de expertos hablar sobre estos temas y otros. También recibiremos una actualización del Capitolio sobre la legislación que afecta a los adultos mayores. Si ya han participado en alguna de nuestras teleasambleas, saben que es similar a un programa de entrevistas de radio y tienen la oportunidad de hacer preguntas en vivo.

 

Para aquellos de ustedes que participan por teléfono, si desean hacer una pregunta sobre la pandemia del coronavirus, presionen *3 en su teléfono para conectarse con un miembro del personal de AARP que anotará su nombre y su pregunta y los colocará en una lista para hacerla en vivo. Si se participan por medio de Facebook o YouTube, pueden publicar su pregunta en los comentarios.

 

Hola, si acaban de unirse, soy Bill Walsh de AARP y quiero darles la bienvenida a este importante debate sobre la pandemia mundial del coronavirus. Estaremos hablando con principales expertos y respondiendo sus preguntas en vivo. Para hacer una pregunta, presionen *3. Y si participan por medio de Facebook o YouTube, pueden publicar su pregunta en los comentarios.

 

Hoy nos acompañan unos invitados destacados, incluidos un experto en salud mental y un neurocirujano. También nos acompañará mi colega de AARP, Jesse Salinas, quien ayudará a facilitar sus llamadas. Este evento está siendo grabado y podrán acceder a la grabación en aarp.org/elcoronavirus 24 horas después de que terminemos. Nuevamente, para hacer una pregunta, presionen *3 en cualquier momento en el teclado de su teléfono para conectarse con un miembro del personal de AARP o, si participan por medio de Facebook o YouTube, dejen su pregunta en la sección de comentarios.

 

Ahora me gustaría dar la bienvenida a nuestro invitado. El Dr. Samoon Ahmad es profesor clínico de Psiquiatría en la Facultad de Medicina Grossmand de NYU. También es el fundador del Integrative Center for Wellness. Escribió un nuevo libro llamado Coping with COVID-19: The Mental, Medical and Social Consequences of the Pandemic. Bienvenido al programa. Dr. Ahmed.

 

Samoon Ahmad: Muchas gracias. Es un placer estar aquí.

 

Bill Walsh: Muy bien. Es un placer tenerlo. El Dr. Brijesh Mehta es el director de Cirugía Neurointervencionista en el Memorial Neuroscience Institute en Florida. Bienvenido al programa, Dr. Mehta.

 

Brijesh Mehta: Muchas gracias. Es un honor estar aquí.

 

Bill Walsh: Muy bien. Gracias a los dos por estar aquí. Y solo un recordatorio para nuestros oyentes, para hacer una pregunta, presionen *3 en el teclado de su teléfono o colóquenla en la sección de comentarios en Facebook o YouTube. Comencemos. Dr. Ahmad, una pandemia mundial, por supuesto, no es una experiencia típica de envejecimiento. ¿Cómo han afectado a los adultos mayores el estrés y la incertidumbre de los últimos dos años?

 

Samoon Ahmad: Bueno, diría que el estrés de la pandemia ha sido difícil para todos. Y yo me incluiría en esa ecuación. Y creo que es importante expresar mis propias preocupaciones para que la gente entienda que en ese momento estaba trabajando en el Bellevue Hospital de la ciudad de Nueva York. Y me contagié de COVID-19 muy pronto. De hecho, era marzo del 2020, y había mucha incertidumbre, ni idea de cuál sería el impacto, de cómo tratar esta enfermedad.

 

Así que fue muy aterrador. Y era como una enfermedad misteriosa en ese momento. Y luego, el año pasado, durante la pandemia, perdí a mi padre, que tenía 90 años. Entonces, puedo entender cuando usa las palabras estrés e incertidumbre, está muy cerca de mi corazón y lo he experimentado yo mismo. Ahora, dicho esto, creo que las circunstancias para las personas mayores han sido excepcionalmente difíciles.

 

Y hay numerosas razones por las que es así, pero me gustaría centrarme, creo, en las importantes, que son dos. La primera es que la COVID-19 tiende a ser más grave en las personas mayores. Por lo tanto, es bastante natural que muchos adultos mayores necesiten ser y sean, de hecho, más diligentes cuando piensan o planean ver a amigos y familiares.

 

Y muchas veces, consideran eso, que el riesgo de asistir a un evento puede ser demasiado alto para ellos. Entonces eligen, ya sabe, "no sé cuántas personas habrá en ese entorno cerrado, cómo voy a interactuar" así que eligen no ir. Ahora, está bien, si uno no acude a uno o dos eventos, no será gran cosa.

 

Sin embargo, cuando comienza a perderse los principales días festivos, cumpleaños u otros hitos con su familia, puede generarle un sentimiento de soledad y desesperación. Y diría que, como tantos otros problemas que surgieron durante la pandemia, la soledad entre las personas mayores existía mucho antes del 2020, particularmente en EE.UU. Pero ya sabe, lo que sucede es que este tipo de aislamiento continuo que estoy describiendo está pesando particularmente más en las personas mayores en este momento.

 

En segundo lugar, las personas mayores de 65 años representan aproximadamente el 75% de todas las muertes por COVID-19, aunque ellos solo representan alrededor del 16% de la población. Y las muertes por COVID-19 también han sido más comunes en hombres mayores que en mujeres mayores por un margen de alrededor de, diría, 50,000. Ahora, esto significa que muchas más mujeres mayores, particularmente mujeres mayores de color, han perdido a un cónyuge. Y esto es emocionalmente difícil, por supuesto, pero también lo es por una variedad de otras razones.

 

Bill Walsh: Doctor, ha hablado sobre algunos de los riesgos emocionales asociados con la COVID-19, el aislamiento, y demás. Me preguntaba si también podríamos hablar sobre otro riesgo, las necesidades de salud no atendidas. Por supuesto, muchas personas pospusieron las citas regulares con su médico debido a la pandemia, porque estaban demasiado nerviosas de ir a un entorno médico.

 

Además, los expertos en salud dicen que es fundamental que los adultos mayores reanuden este tipo de atención preventiva, y los exámenes de detección son uno de los exámenes preventivos más importantes para los adultos mayores. Entonces, Dr. Ahmad, por qué no comienza, y Dr. Mehta, le preguntaré a usted también.

 

Samoon Ahmad: Bien. Cuando pensamos en los exámenes preventivos para adultos mayores, hay una lista normal de pruebas a las que están muy acostumbrados cuando ven a su médico, pero creo que puede buscar ciertos signos y síntomas si busca en amigos y familia o para uno mismo si está cuidando a alguien que es significativamente mayor. Y creo que es importante pensar en los adultos mayores como un solo grupo cuando uno tiene alrededor de 60 años, yo tengo 60 y mi padre tenía 90. Así que tenemos experiencias pandémicas muy diferentes. Y deberíamos ser evaluados para diferentes cosas.

 

Para quienes somos mayores, pero todavía cerca del grupo de mediana edad, debemos ser examinados para detectar ansiedad, depresión, trastornos de duelo prolongado. Y no se hace esto por notar sentimientos de tristeza, más bien, se puede notar una falta de interés en hacer cosas, ansiedad, irritabilidad, podría haber un mayor consumo de alcohol o cambios drásticos en el peso o los patrones de sueño.

 

Ahora bien, para las personas más cercanas a mi padre en ese grupo de edad, la sintomatología puede ser un poco diferente. Y siempre deben buscar cosas como cambios de peso y disminución del interés. Pero lo importante es que, en ese grupo de edad, los problemas cognitivos son un síntoma importante, sobre todo, de depresión en personas de edad avanzada. Y en cambio, el síntoma se observa raramente en personas más jóvenes.

 

De hecho, dentro del campo de la psiquiatría, lo llamamos pseudodemencia. Y casi imita ese cuadro, y los pacientes parecen estar perdiendo sus facultades cognitivas e intelectuales, pero cuando se los trata por depresión, de repente los síntomas desaparecen, lo que en realidad nos dice que, no, esto no es algo que tenga una causa orgánica de demencia ni nada por el estilo.

 

Son solo síntomas que se mimetizan. Y eso es algo muy importante, porque los cónyuges pueden notar, o los nietos, los hijos, cualquiera puede notar que algo está pasando, que les cuesta recordar cosas o que pierden las cosas o no están atendiendo sus cuentas a tiempo, cualquiera de esas cosas. Depende del grupo de edad, pero esa es una forma de hacer un examen preventivo.

 

Bill Walsh: Muchas gracias, Dr. Ahmad. Dr. Mehta, ¿quería agregar algo a esa lista de exámenes preventivos que las personas deberían estar haciéndose en este momento?

 

Brijesh Mehta: Sí, estoy de acuerdo con el Dr. Ahmad en que, especialmente durante la pandemia con el aislamiento social, la salud mental está ciertamente en primera línea ahora mismo. Y especialmente si un paciente, las personas, tenían enfermedades preexistentes, que, según los estudios, se han exacerbado en los últimos dos años. Así que, ciertamente, es primordial reanudar, mediante los servicios preventivos, algunas de las pruebas de detección de problemas cognitivos, ansiedad y depresión, como ha señalado.

 

Y desde el punto de vista cardiovascular y cerebrovascular, también es importante que, a medida que los pacientes, la población en general, se sienta más cómoda para volver al hospital, para volver a la clínica y ser atendidos por su proveedor de atención primaria, se los examine para detectar los factores de riesgo de diabetes o presión arterial alta, hiperlipidemia, es decir, colesterol alto, así como asesoramiento sobre el tabaquismo, en particular si tendieron a aumentar o empeorar sus hábitos como fumadores durante la pandemia. Cualquiera de estas afecciones y adicciones debería requerir algún tipo de asesoramiento y atención preventiva, lo que incluye el cumplimiento de la medicación.

 

Bill Walsh: Sí. Muchas gracias por eso. Déjeme continuar, Dr. Mehta. Según el Journal of the American Medical Association, la incidencia de ataques de corazón y derrames cerebrales había estado disminuyendo antes de la pandemia, pero ahora ha cambiado de rumbo, con diferencias exageradas entre las poblaciones minoritarias. ¿Por qué estamos viendo tantos problemas cardíacos relacionados con la pandemia? ¿Y por qué las poblaciones negras y morenas enfrentan un mayor riesgo?

 

Brijesh Mehta: Es una gran pregunta. En el estado de Florida, donde ejerzo, mediante el Florida Stroke Registry y otros organismos similares, hemos estudiado las disparidades en la atención médica, especialmente en las poblaciones minoritarias, y lo que hemos averiguado es que se trata de algo multifactorial.

 

Hay razones para ello que deberían abordarse con medidas epidemiológicas, como el acceso general a los servicios preventivos que acabamos de comentar, así como la capacidad financiera para permitirse ir al médico, pagar los medicamentos y, específicamente para el derrame cerebral, la prevención secundaria de este tipo de problemas es muy importante.

 

Hemos observado, especialmente en los últimos dos años y medio durante la pandemia, que después de que un paciente sufriera un primer ataque isquémico transitorio o un derrame cerebral, han disminuido su cumplimiento y su capacidad para hacer un seguimiento regular y asegurarse de que tomaban la medicación adecuada.

 

Y también, especialmente entre los afroamericanos y otras poblaciones minoritarias, creo que ha habido, lamentablemente, una desconfianza generalizada en el sistema de atención médica, y especialmente en las figuras de autoridad, y eso se ha reportado en los últimos años, y es algo en lo que nosotros, como autoridades médicas, las instituciones de atención médica estamos trabajando activamente para tratar de tranquilizarlos de que nos interesa tratar su salud, la de sus familias, y que queremos lo mejor para sus enfermedades crónicas.

 

Bill Walsh: Bueno, quisiera hablar sobre algunas de las otras complicaciones relacionadas con la COVID-19. Por supuesto, los CDC informaron recientemente que el 60% de la población de EE.UU. se había infectado con COVID-19 en algún momento. Ahora, las complicaciones de COVID-19, incluso en casos leves, han incluido problemas como coágulos de sangre, enfermedades cardíacas, derrames cerebrales, como acaba de decir, y diabetes. ¿Cuáles son los riesgos a largo plazo, Dr. Mehta, si uno ha tenido COVID-19?

 

Brijesh Mehta: Sí. Estamos aprendiendo continuamente más sobre la realidad de la COVID-19 prolongada, si se quiere, y cuáles son los diversos multisistemas que podría abarcar y afectar. Y, particularmente en mi especialidad, en neurociencia neurocirugía, lo que hemos visto como efectos persistentes de COVID-19 e incluso en personas que inicialmente pueden haber sido asintomáticas, es, como el Dr. Ahmad aludió antes, la depresión, la ansiedad, la fatiga generalizada, el malestar, algunos de estos síntomas que hemos visto en alrededor de 30 a 40% de nuestros pacientes infectados por COVID-19.

 

Y la etiología de por qué lo estamos viendo en esta población, semanas y meses después de la infección inicial, todavía la estamos aprendiendo, pero tiene algo que ver con la respuesta autoinmunitaria persistente y continua y la inflamación dentro de los vasos sanguíneos.

 

Especialmente en el punto álgido de la pandemia, de forma similar a lo que los científicos observaron en el noreste, también vimos en Florida el aumento del riesgo de derrame cerebral entre los pacientes que tenían COVID-19. Y, lamentablemente, a pesar de la intervención urgente, esos pacientes tuvieron peores resultados, incapacidad para desobstruir esas arterias debido a los trastornos de la coagulación como resultado de la COVID-19.

 

Bill Walsh: Bueno, permítame continuar con lo que mencionó, el derrame cerebral. Me pregunto si podría compartir rápidamente las señales de advertencia que deberían llevar a alguien a ponerse en contacto con su médico si cree que podría haber sufrido un derrame cerebral o tal vez ha visto a un ser querido que está sufriendo algunos de esos síntomas.

 

Brijesh Mehta: Seguro, absolutamente. Al ser mayo el Mes de la Concientización sobre el Derrame Cerebral, estamos haciendo todo lo posible en nuestra comunidad local y más allá para educar a los pacientes y a las personas en riesgo sobre los signos y síntomas del derrame cerebral. Entonces, el acrónimo que usamos y ha sido defendido por la American Stroke and Heart Association, es BE-FAST en inglés, que se traduce como equilibrio, ojos, cara, brazo, habla y tiempo.

 

Entonces, si una persona tiene una repentina dificultad para caminar, o para mantener el equilibrio, problemas para ver, de repente disminuye su campo visual o tienen visión doble, dificultad con las expresiones faciales. Y generalmente son los seres queridos los que captan algunas de estas pistas sutiles, como la caída facial, la asimetría de su rostro. Y digamos que están sosteniendo un bolígrafo o una taza de café, y de repente tienen debilidad en ese brazo o mano o dificultad para articular palabras, que es la parte del habla.

 

El tiempo es esencial, y alentamos a las familias o personas que puedan estar sufriendo estos signos o síntomas a llamar al 911 inmediatamente. Cada minuto que transcurre después de la aparición de síntomas similares a los de un derrame cerebral, alrededor de 2 millones de neuronas están en riesgo de daño permanente. Entonces, cuanto más rápido reciban atención, mejor será el resultado que puedan lograr.

 

Bill Walsh: Bien, muchas gracias Dr. Mehta. Ahora, hemos estado hablando sobre algunas de las complicaciones físicas asociadas con la COVID-19. Permítanme hablar sobre algunos de los problemas de salud mental. En una encuesta reciente de AARP, encontramos que más del 30% de los adultos mayores se han sentido molestos por la ansiedad, han tenido poco interés o placer en hacer cosas y han tenido sentimientos de depresión o desesperanza. Foreign 10 dice que no pueden recuperarse fácilmente de las dificultades. Dr. Ahmad, ¿a dónde acuden los adultos mayores en busca de ayuda si tienen sentimientos de desesperanza, pérdida o depresión?

 

Samoon Ahmad: Bueno, creo que en primer lugar, en mi opinión, deberían acudir, y al mismo tiempo deberían ser correspondidos, a la familia. En particular, diría que en este momento hay mucho menos estigma sobre los problemas de salud mental entre las personas más jóvenes, y la pandemia incluso ha hecho que sea más aceptable socialmente tener esta conversación.

 

Entonces, hablen con los niños, hablen con los nietos, van a ser mucho más empáticos de lo que creemos que son. Y si uno no se siente cómodo para hablar con la familia o cree que necesita la ayuda de un profesional de la salud mental, los terapeutas autorizados están capacitados para ayudar a las personas que luchan contra la depresión, la ansiedad o una sensación general de malestar.

 

Si bien están especialmente capacitados, los consejeros de duelo pueden ayudar a quienes han perdido a alguien cercano. Primero, les sugiero que hablen con el médico de atención primaria y le pidan recomendaciones. Y si desean explorar otras opciones, vecinos, socios y amigos en quienes confían. Y si uno es más bien una persona religiosa, le recomendaría hablar con el líder de su congregación, que a menudo tiene una sólida formación en consejería y ofrece consuelo a aquellos que se sienten sin rumbo o perdidos.

 

Y también pueden recomendar, de hecho, un profesional de la salud mental. Finalmente, creo que cosas como los niveles de estrés, la cantidad de luz solar que recibe, cuántas horas duerme y la dieta realmente pueden afectar el estado de ánimo. De hecho, hubo una revisión y un análisis que demostró que en una enorme cantidad de datos, alrededor de dos millones de personas al año, se descubrió que las personas que hacían una cantidad moderada de ejercicio, lo que equivale a unas dos horas y media a la semana de solo caminar a paso ligero, tenían muchas menos probabilidades de estar deprimidas.

 

Y creo que es importante pensar que a mucha gente le gusta compartimentar el cuerpo y la mente, pero ambos están íntimamente conectados, y uno puede acabar sintiéndose bastante oprimido y deprimido por los sentimientos negativos si no lleva un estilo de vida saludable. Así que, por lo tanto, consideraría, de hecho, unirme a algún tipo de centro para adultos mayores u otro lugar. Y al hablar de ejercicio no quiero que la gente tenga la impresión de que estoy hablando de algo arduo y agotador.

 

No, solo estoy hablando de la actividad física normal de caminata rápida, jardinería, ya sabe, andar en bicicleta, tomar clases de cocina o comidas más saludables. Solo necesita unos 30 o 40 minutos para salir y hacer cosas. Pero esa sería una forma de empezar. Yo diría que para comenzar, ya sea su vecino o su amigo o una familia o un médico de cabecera que puede recomendar y ser alguien que puede hacer esa recomendación para usted.

 

Bill Walsh: Bueno, como recordatorio para nuestros oyentes, si desean unirse a la conversación y hacer una pregunta en vivo, presionen *3 en el teclado de su teléfono en cualquier momento. Y si están en Facebook o YouTube, dejen su pregunta en la sección de comentarios.

 

Ahora, Dr. Ahmad, a veces se estigmatiza el tratamiento de salud mental, como si fuera un signo de debilidad. ¿Hemos visto mejoras relacionadas con eso durante la pandemia? ¿Y cómo se pueden establecer la confianza y la conciencia, particularmente con las comunidades étnicas donde hay mucha desconfianza?

 

Samoon Ahmad: Bueno, creo que número uno, no hay duda de que en comparación entre donde estábamos y donde estamos en este momento, ha habido un cambio sucinto en este punto, en comparación con lo que existía antes. Así que creo que diría que la gente busca mucha más ayuda en este momento. La gente habla, saca a relucir muchas veces los síntomas físicos, y una vez que se empieza a hablar de los síntomas físicos —intento establecer esa conexión entre lo mental y lo físico y las relaciones recíprocas entre ambos— la gente está mucho más abierta.

 

Y hay un cambio en términos de atención médica virtual, que también está disponible en este momento. Ahora bien, de ninguna manera sustituye a la reunión real, en persona, pero las personas están mucho más dispuestas a sentarse en la comodidad de su hogar porque les preocupa salir o estar con otra persona y los riesgos que acarrea. Entonces, también desde esa perspectiva, las personas son mucho más abiertas en términos de poder buscar ayuda.

 

Bill Walsh: Genial. Bueno, eso es una gran noticia. Y gracias por esa actualización. Dr. Ahmed. Hablemos un poco sobre los recursos que la gente puede usar. Saben, hay una discusión muy importante dado que mayo es el Mes de Concientización sobre la Salud Mental, quería recordarles que AARP tiene excelentes consejos, herramientas y recursos gratuitos sobre salud mental que se pueden encontrar en nuestro Centro de Recursos de Salud Mental.

 

Esa dirección es www.aarp.org/mentalhealth, todo en una sola palabra. Repito, www.aarp.org/mentalhealth. O si se sienten aislados y necesitan una voz amiga, llamen a la línea gratuita de voces amigables, de AARP, al 888-281-0145. Repito, 888-281-0145. Una vez más, ese es un servicio gratuito en inglés y en español.

 

Y como recordatorio, para nuestros oyentes, para hacer su pregunta a nuestros expertos presionen *3 en cualquier momento en el teclado de su teléfono. O dejen sus preguntas en la sección de comentarios de Facebook o YouTube. Vamos a tomar esas preguntas en vivo pronto. Pero antes de hacer eso, quería traer a Megan O'Reilly. Megan es la vicepresidenta de AARP para la salud y la familia y actualizará a nuestros oyentes sobre cómo AARP está luchando por ellos. Bienvenida al programa, Megan.

 

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

 

Bill Walsh: Muy bien. ¿Cuáles son las últimas noticias en el frente de la defensa?

 

Megan O’Reilly: La máxima prioridad de AARP sigue siendo nuestra lucha para reducir los precios de los medicamentos recetados para los adultos mayores. Las encuestas recientes demuestran que este es el problema de salud número uno que los votantes quieren que el Congreso aborde este año, y también nuestro problema número uno.

 

Durante años, el Congreso ha prometido abordar el aumento vertiginoso de los precios de los medicamentos recetados, y finalmente estamos en la cúspide de ver el cambio. Nunca hemos estado tan cerca de una reforma importante en cuanto a medicamentos recetados, y debe aprobarse ahora.

 

Bill Walsh: Bueno, ¿qué tipo de reformas de medicamentos recetados estamos impulsando?

 

Megan O’Reilly: Por encima de todo, queremos que se permita a Medicare negociar precios más bajos de medicamentos. También queremos poner un límite a los gastos de bolsillo de los adultos mayores por lo que pagan por sus medicamentos recetados. Queremos ver sanciones impuestas a las compañías farmacéuticas que aumentan sus precios más rápido que la tasa de inflación.

 

Las personas mayores están hartas y cansadas de pagar los precios más altos del mundo por sus medicamentos y quieren alivio. De hecho, sabemos que más del 80% de los votantes de todos los partidos apoyan estas reformas que ayudarían a las familias a pagar los medicamentos y ahorrarían a los contribuyentes miles de millones de dólares cada año.

 

Bill Walsh: Está bien. Ahora, esta semana, AARP también respaldó una legislación que amplía la atención domiciliaria para veteranos. ¿Qué nos puede decir al respecto?

 

Megan O’Reilly: Absolutamente. AARP respaldó la Ley de servicios basados ​​en el hogar y la comunidad para veteranos y cuidadores de Elizabeth Dole del 2022. Esta legislación ampliaría el acceso para mejorar la coordinación entre los programas del VA y también mejoraría el apoyo para los veteranos y sus cuidadores familiares.

 

Bill Walsh: Ahora, ¿por qué es eso tan importante, Megan?

 

Megan O’Reilly: Sabe, los veteranos deberían poder permanecer viviendo en su hogar el mayor tiempo posible. Y esta legislación les ayudaría a hacer eso. Después de prestar servicio a nuestro país, estos hombres y mujeres merecen vivir con independencia, seguridad y dignidad. AARP está luchando para que todos los veteranos tengan opciones asequibles y de alta calidad cuando se trata de atención a largo plazo, especialmente su atención en el hogar.

 

Bill Walsh: Bueno, finalmente, si nuestros oyentes quieren estar al tanto de las noticias de promoción de AARP, ¿cómo pueden encontrar las últimas actualizaciones?

 

Megan O’Reilly: Es muy importante estar al tanto de los problemas que le afectan a uno y a todas las personas de 50 años o más, los animamos a conectarse en línea y buscar AARP Fighting for You. Eso los llevará a un resumen diario de las últimas noticias y actualizaciones de defensa. Es una excelente manera de mantenerse informados y alentamos a todos a que lo visiten.

 

Bill Walsh: Está bien, genial. Así que busquen AARP Fighting for You. Muchas gracias, Megan, por estar con nosotros hoy.

 

Megan O’Reilly: Gracias, Bill.

 

Bill Walsh: Bien. Y como un recordatorio para nuestros oyentes, presionen *3 en cualquier momento en el teclado de su teléfono para hacer una pregunta a nuestro experto en salud mental y a nuestro neurocirujano que están en línea esperando responder esas preguntas. Ahora es el momento de abordar esas preguntas con el Dr. Samoon Ahmad y el Dr. Brijesh Mehta. Como dije, presionen *3 en cualquier momento en el teclado de su teléfono para conectarse con un miembro del personal de AARP para ingresar a la fila y hacer su pregunta en vivo. Y si desean escuchar en español, presionen *0 en el teclado de su teléfono ahora.

 

[En español]

 

Bill Walsh: Muy bien, ahora me gustaría traer a mi colega de AARP, Jesse Salinas, para ayudar a facilitar sus llamadas. Bienvenido, Jesse.

 

Jesse Salinas: Muchas gracias por recibirme hoy, Bill.

 

Bill Walsh: Muy bien, ¿a quién tenemos primero?

 

Jesse Salinas: Nuestra primera pregunta vendrá de YouTube. Es de Craig, en Oklahoma. Y su pregunta es: mi familia tiene antecedentes de derrames cerebrales. ¿Corro un mayor riesgo debido a la COVID-19, o qué debo hacer para protegerme?"

 

Bill Walsh: Eso parece una buena pregunta para el Dr. Mehta. Dr. Mehta, ¿puede respondernos eso?

 

Brijesh Mehta: Sí, esa es una gran pregunta. Si una persona tiene antecedentes familiares de derrames cerebrales, ya sea debido a la obstrucción de una arteria en el cerebro o debido a una hemorragia cerebral, ambos se consideran entre los varios subtipos de derrames cerebrales.

 

Y es importante que cuando los evalúe un neurólogo, idealmente un neurólogo especialista en derrames cerebrales, o su médico de atención primaria, se identifiquen claramente algunos de esos factores de riesgo por los que sus familiares sufrieron derrames cerebrales, como problemas prevenibles como colesterol alto, presión arterial alta, diabetes, tabaquismo.

 

Y si alguno de los pacientes o familiares tiene factores de riesgo similares, entonces es el momento adecuado para controlarlos, ya sea mediante modificaciones del estilo de vida o el ejercicio y el cumplimiento de la medicación. Y si a pesar de este tipo de intervenciones sigue siendo difícil, a veces la genética interviene de forma significativa.

 

Por ello, es importante tomar la medicación adecuada y someterse a otros exámenes, dadas las diversas etiologías y causas de los derrames cerebrales, como la coagulación de la sangre, para asegurarnos de identificarlas, especialmente a una edad temprana, de modo que se pueda vivir una vida larga y saludable.

 

Sabemos que la COVID-19 aumenta el riesgo de sufrir un derrame cerebral, independientemente de los antecedentes familiares. Y cuando los pacientes tienen COVID-19, lamentablemente, no se entiende del todo por qué algunos pacientes tienen problemas de coagulación y otros no, pero una vez que se identifica, es importante tomar anticoagulantes y también asegurarse de que toda enfermedad subyacente, como la diabetes, la obesidad o la hipertensión, se modifique en la medida de lo posible.

 

Bill Walsh: Muy bien, Dr. Mehta. Muchas gracias por eso. Jesse, ¿a quién tenemos ahora?

 

Jesse Salinas: Nuestra próxima pregunta será de Ted, en Nevada.

 

Bill Walsh: Hola, Ted, bienvenido a nuestro programa. Adelante con su pregunta.

 

Ted: Me pregunto sobre el sueño, ¿cuántas horas de sueño necesito? Tengo todos los síntomas. ¿Es más útil dormir más?

 

Bill Walsh: ¿Si tener más horas sueño es útil para prevenir la COVID-19 o tratar la COVID-19? ¿Es esa su pregunta?

 

Jesse Salinas: Creo que eso es todo, Bill...

 

Bill Walsh: Está bien, está bien. Dr. Ahmad, me pregunto si puede hablar sobre la importancia del sueño, la necesidad de dormir, y tal vez en alguien que se está recuperando de COVID-19 o que lo está intentando.

 

Samoon Ahmad: Muy bien. Creo que, de alguna manera, la persona que llama tiene razón en que el sueño es una de las necesidades esenciales más fundamentales. Y, de hecho, muchas personas que luchan contra la depresión, la ansiedad, uno de los principales aspectos que es una comorbilidad son los problemas de sueño en esos pacientes.

 

Y el sueño por sí mismo, obviamente, es solo un síntoma de una enfermedad subyacente, y las personas que no duermen bien o tienen dificultades, aparte de tratarse de la ansiedad y la depresión, quiero enfatizar, y el Dr. Mehta, puede explicar más.

 

Pero esas cosas conducen a más estrés. Y el estrés, de hecho, conduce a esta cascada de todo tipo de hormonas y neurotransmisores que predisponen a una persona durante un período prolongado a muchas de las dolencias crónicas, que pueden incluir ataques cardíacos, niveles altos de azúcar en la sangre o diabetes, obesidad, o inflamación en el cuerpo, que también causa neuroinflamación, que luego puede predisponerlo no solo a problemas psiquiátricos, ansiedad, depresión, sino a muchas otras enfermedades que pueden tener que ver con trastornos cognitivos, enfermedad de Parkinson y otros problemas.

 

Por lo tanto, abordar el sueño es esencial, tanto psicológica como mentalmente, porque pensar en cualquier cosa que sucede en la mente, como si se quedara por encima del cuello, ya sabe, cosas que suceden por encima de la cabeza, no es como Las Vegas, lo que sucede en Las Vegas permanece allí, tiene relaciones recíprocas en todo el cuerpo. Y es esencial abordarlas realmente.

 

Entonces, las personas con dolencias crónicas tendrán problemas para dormir, sin lugar a dudas. Y si uno es obeso o tiene más peso, la apnea del sueño puede a veces predisponerlo y tiene más riesgo de hipertensión por eso. Así que las personas con enfermedades mentales u otras afecciones pueden tener problemas de sueño. Las personas que tienen muchas dolencias físicas, tendrán problemas de sueño. Y luego, en reciprocidad, tienen problemas en términos de todas las dolencias crónicas que acabo de mencionar.

 

Bill Walsh: Está bien. Muchas gracias, Dr. Ahmad. Jesse, ¿de quién es nuestra próxima llamada?

 

Jesse Salinas: Nuestra próxima llamada proviene de YouTube, LM pregunta: desde la pandemia de COVID-19, mi ansiedad ha aumentado. ¿Cuáles son algunos consejos para sobrellevar ese tipo de ansiedad?

 

Bill Walsh: Dr. Ahmad, también parece adecuado para responder esta pregunta.

 

Samoon Ahmad: Sí. Por supuesto, tiene toda la razón. Por lo general, la prevalencia de la ansiedad es de aproximadamente el 7 u el 8%. Ahora ronda entre el 39 y el 40%. Y los síntomas de ansiedad, la mayoría de las veces, son los que experimentan las personas, lo cual es natural en este punto. Pero creo que hay algunas estrategias de recuperación que las personas pueden incorporar a su vida, específicamente hablo de ejercicios de respiración.

 

La gente tiende a ignorar la importancia de la respiración, y la razón por la que menciono el tema de la respiración es que esta aumenta lo que pensamos que es el sistema de control del organismo. Disminuye el ritmo cardíaco. Reduce el estrés en general. Entonces, tomando tiempo, diría de 10 a 15 minutos, tres veces al día, lo que llamamos una respiración dominante, por ejemplo, que consiste en sentarse en posición vertical e inhalar tanto como pueda profundamente, tratar de contener la respiración y luego exhalar durante el doble de tiempo que la inhalación.

 

Tratar de visualizar un lugar pintoresco o hermoso que normalmente a uno le gustaría ir y visitar e intentar hacer esto. Esa es una forma de controlarlo. La segunda sería lo que llamamos técnicas de relajación muscular. Y la idea es, de nuevo, sentarse en una postura erguida y pensar desde los dedos de los pies hasta el cuello, poner los músculos en una contracción extrema, mantenerlos durante un breve período, y luego soltarlos, relajarlos de repente. Entonces tenemos esas dos técnicas.

 

Pero aparte de eso, hay otras cosas, hacer cosas fuera de la actividad física. Esa también es una forma de mitigar el estrés. Meditación, yoga, esas son algunas de las otras estrategias en las que quizás quiera pensar. Creo que los cambios en el estilo de vida en general son un elemento extremadamente importante para reducir la ansiedad.

 

Además del hecho de que es posible que desee hablar con alguien o buscar ayuda o, en los casos en que llegue al punto en que tenga dificultades para funcionar personalmente, profesionalmente, es posible que necesite buscar ayuda profesional para algunos otros tratamientos médicos.

 

Bill Walsh: Bien, muchas gracias por eso, Dr. Ahmad. Jesse, tomemos otra pregunta.

 

Jesse Salinas: Sí. Nuestra próxima pregunta viene de Sue, en Nueva York.

 

Bill Walsh: Hola, Sue, bienvenida a nuestro programa. Adelante con su pregunta.

 

Sue: Sí, tengo un cardiólogo que solo quiere hacer una prueba de esfuerzo de rutina. Y él quería que tomara la medicación, le dije que no, que eso es una locura, porque tengo una rodilla mal. Pero creo que podría hacer la otra. Pero el punto es que no quiero ir al hospital y que me hagan esto. Y no hay razón para hacerlo. No tengo enfermedades preexistentes. Quiero decir, tengo ERGE y hernia hiatal y fibromialgia e hipotiroidismo.

 

No tengo ninguna enfermedad del corazón. Ahora, mi papá murió de un derrame cerebral a la edad de 70 años y yo tengo 72. Pero no quiero correr el riesgo, porque la COVID-19 es muy alta aquí. ¿Por qué estaría pidiendo esto? Sí creo que me hice un electrocardiograma y estuvo bien. Y no hubo problemas. Él dijo eso. ¿Por qué la gente tiene que hacerse una prueba de estrés de rutina? ¿Es algo que tiene que tener a cierta edad y por qué querría hacer eso ahora?

 

Bill Walsh: Está bien, bueno, preguntémosle al Dr. Mehta. Dra. Mehta, ¿puede ayudar a Sue?

 

Brijesh Mehta: Hola, Sue, esa es una buena pregunta. Y sin duda merece la pena cuestionar la indicación de la prueba de esfuerzo cardíaco. A menos que tenga algunos síntomas continuos, como dolor en el pecho durante el ejercicio, o incluso durante las actividades diarias, como caminar, trabajar en casa, pero por lo que ha descrito, no veo una fuerte indicación para someterse a una prueba de esfuerzo cardíaco.

 

No es parte de la rutina, el Grupo de Trabajo Preventivo de EE.UU. tiene una guía para las personas mayores, es decir, las personas mayores de 65 años, para someterse a una prueba de esfuerzo cardíaco, a menos que tenga alguno de los síntomas, como dolor en el pecho, dificultad para respirar al hacer esfuerzos, ya sabe, es decir, con actividades de rutina. Y, por lo tanto, vale la pena cuestionar, en lo que respecta a las preocupaciones sobre ir al hospital debido a los aumentos repentinos de COVID-19, y ciertamente comparto esa preocupación.

 

Sabe, lo que puedo asegurarle solo desde el punto de vista de una institución de atención médica, cualquier centro que atiende a pacientes en Estados Unidos ha recibido una amplia capacitación y existen protocolos de seguridad para garantizar que los pacientes se mantengan a salvo cuando vienen por cualquier otro problema médico. Y todo el personal está capacitado para mantener esos entornos separados de las unidades de COVID-19, y también tener a mano el equipo de protección personal adecuado. Así que solo quería tranquilizarla sobre eso.

 

Bill Walsh: Bien, gracias por eso, Dr. Mehta. Y gracias por todas esas preguntas. Pronto responderemos más. Y como recordatorio, si desean ponerse en la cola para hacer su pregunta, presionen *3 en el teclado de su teléfono en cualquier momento. Dr. Ahmad, quería volver a usted. En los últimos años hemos visto un aumento de las opciones de salud mental en línea o virtual, realizado de forma remota a través de la computadora o tableta. ¿Es la salud mental virtual capaz de replicar el tratamiento presencial? ¿Es eficaz?

 

Samoon Ahmad: La respuesta corta es no, pero yo diría que, incluso la psicoterapia, que es el uso más común de la telesalud y se basa en gran medida en la comunicación verbal, los terapeutas pueden recopilar mucha información. Pero yo diría, si está tratando de evaluar en términos de algunos de los síntomas que nos gustaría ver, por ejemplo, una persona que está sentada quejándose de ansiedad, pero ve que tiembla un poco, que está un poco inestable, claramente no puede evaluar esas cosas mientras está en una plataforma de telesalud.

 

Las personas, como seres humanos, siendo animales sociales, prefieren conectarse con los demás en persona. Sin embargo, las señales visuales, estar muy cerca de otra persona, ver las expresiones faciales en persona en lugar de Zoom o FaceTime, son dos formas muy diferentes de comunicarse.

 

Así que creo que durante los últimos dos años, obviamente, debido a las preocupaciones, creo que brindó un gran servicio, no hay duda al respecto, los pacientes pudieron obtener una gran ayuda. Así que no estoy minimizando eso de ninguna manera, pero diría que si hay una opción y si las personas son capaces de arreglárselas, todavía sugeriría un tratamiento en persona en este momento.

 

Bill Walsh: Está bien. Gracias por eso. Y permítame continuar brevemente. Me preguntaba sobre las consideraciones de costos, ¿la telemedicina de salud mental está cubierta por un seguro privado o Medicare?

 

Samoon Ahmad: Bueno, durante un tiempo, sí. Luego surgió este tipo de pregunta, de que debemos detener eso, pero con un poco de defensa del paciente y mucho apoyo y la gente todavía está bastante preocupada por eso, la mayoría de los seguros incluso Medicare cubre parcialmente o, ya sabe, en gran medida, el uso de la medicina de telesalud.

 

Y particularmente con los seguros privados, varía, por ejemplo, a través de las fronteras estatales, las personas lo podían usar y eso se está volviendo un poco más limitado. En un momento dado se amplió por completo para que la gente pudiera recibir la ayuda adecuada. Así que hay muchas variables, pero es difícil responder a la pregunta de forma puramente afirmativa o negativa, pero sí, tal y como está el sistema ahora mismo, Medicare cubre. Hasta cierto punto, también lo hacen los seguros privados.

 

Bill Walsh: Bien, gracias por eso. Dr. Mehta. Déjeme volver a usted. El año pasado, la FDA aprobó poderosos medicamentos antivirales para la COVID-19 y ahora estamos viendo un aumento en la producción y disponibilidad. ¿Qué son los antivirales y por qué son importantes?

 

Brijesh Mehta: Bill, esa es una buena pregunta. Bueno, los antivirales, han existido durante una buena parte de los últimos 50 o 60 años. Y básicamente, funcionan uniéndose a los receptores dentro de las células del cuerpo que pueden estar infectadas con el virus y evitan que el virus se replique dentro de esas células. Y la mayoría de los antivirales que hay en el mercado, algunos de nuestros oyentes ya estarán familiarizados, por ejemplo, el medicamento antiviral Tamiflu para la gripe.

 

Y ahora con la COVID-19, como mencionó, la FDA aprobó el antiviral de Pfizer que se llama Paxlovid. Y básicamente, el objetivo es prevenir cualquier empeoramiento de los síntomas de COVID-19 en una enfermedad más grave, que puede afectar los pulmones, el corazón y, como hemos discutido, otras partes del cuerpo, incluido el cerebro. La clave es tomarlo dentro de los primeros días del inicio de los síntomas. Y tengan en cuenta que esto no está aprobado para todos y cada uno de los pacientes que se infectan con COVID-19.

 

Es para aquellos que tienen un riesgo particularmente alto, esa categoría se define como aquellos adultos de 65 años o más y aquellos con ciertos trastornos subyacentes, como enfermedades cardíacas, cáncer, diabetes u obesidad. Y entonces, no es un sustituto de la vacuna. Esto es para pacientes que están en esa categoría de alto riesgo y se ven afectados por COVID-19, ciertamente puede prevenir algunas de las secuelas posteriores.

 

Bill Walsh: Ahora, déjeme preguntarle en este momento, parece que la COVID-19 está disminuyendo, las hospitalizaciones han disminuido, etcétera. Ya sabe, para las personas que no recibieron una vacuna o, no pudieron vacunarse porque sus sistemas se vieron comprometidos por alguna otra razón. ¿Cómo manejan las actividades sociales y el ejercicio? ¿Qué consejo les daría en este momento de la pandemia?

 

Brijesh Mehta: Bien, creo que es importante enfatizar, para aquellas personas que así como lo fue durante las peores oleadas de la pandemia, que esto todavía se reduce a nuestra responsabilidad individual, ¿verdad? Que si bien podemos estar fuera de la peor parte de la pandemia, en términos de carga de casos y los sistemas de atención médica sobrecargados, todo se reduce a asegurarnos de que seguimos usando mascarillas, especialmente en áreas altamente concentradas, reuniones sociales breves y, en particular, si tienen síntomas, ejercer esa responsabilidad, asegurarse de seguir las pautas de los CDC para la cuarentena, especialmente en los primeros días después de la aparición de los síntomas, y practicar ese distanciamiento social. Y llevar una mascarilla sigue siendo muy útil y la medida preventiva más eficaz para proteger a nuestros seres queridos en la comunidad.

 

Bill Walsh: Ahora, por supuesto, hemos visto que muchos dejaron de usar mascarilla en las últimas semanas, si uno es la única persona en la habitación que la usa, ¿hay algún beneficio?

 

Brijesh Mehta: Ciertamente, todos hemos estado en situaciones en las que, dependiendo de nuestro nivel de comodidad individual, así como de la incertidumbre sobre quién puede o no ser sintomático, tomamos esa decisión personal de usar una mascarilla. Sigue siendo muy útil porque una mascarilla, como han demostrado los datos, puede reducir la inhalación general de estas gotas de aerosol, que es como se transmite la COVID-19, entre un 50 y un 70%.

 

Entonces, al tener una mascarilla de tela de múltiples capas, incluso si uno es el único en la habitación que la usa, esencialmente se está protegiendo a sí mismo, así como cuando está hablando o formando parte de una conversación normal, si uno tiene síntomas y, sin saberlo, tal vez esté infectado con COVID-19, también está protegiendo a otros de contraerlo.

 

Bill Walsh: Correcto. Bueno. Y una última pregunta para usted, Dr. Mehta. Me pregunto, ¿la COVID-19 puede dañar directamente el cerebro? Un estudio reciente que se publicó en el Journal of Psychiatric Research descubrió que algunas personas se han vuelto más olvidadizas y más lentas para procesar la información después de contraer COVID-19. ¿Esta niebla COVID-19 es COVID-19 prolongada u otra cosa? ¿Y cuál es la causa? ¿Qué debe saber la gente sobre eso?

 

Brijesh Mehta: Sí, esa es una buena pregunta. Lo que hemos visto en nuestras clínicas de seguimiento neurológico, especialmente después de un derrame cerebral que tendemos a ver y que puede haber sido infectado simultáneamente con COVID-19 en el momento de la admisión inicial, estamos viendo y escuchando de nuestro neurólogo de la comunidad que estos pacientes se presentan con problemas cognitivos como dijo, el olvido, la dificultad para realizar las actividades más simples de la vida diaria que todos damos por sentado, balancear chequeras, tareas en la casa.

 

Y ahora estamos en el proceso de seguir aprendiendo más, como parte de estudios nacionales, pero ciertamente es algo que, como discutimos antes, tiene que ver con la respuesta inflamatoria continua que daña las neuronas en el cerebro, y ese tipo persistente de respuesta autoinmunitaria es lo que está causando estos efectos a largo plazo, y no es algo para tomar a la ligera. Y estamos registrando a estos pacientes en nuestra clínica como parte de nuestra evaluación para ver quién todavía sufre los síntomas a largo plazo y seguir aprendiendo de ello.

 

Bill Walsh: Está bien. Muchas gracias. Dr. Ahmad, no sé si quería opinar sobre la noción de niebla COVID-19.

 

Samoon Ahmad: Bien. Estoy completamente de acuerdo con el Dr. Mehta y simplemente ampliaría lo que acaba de mencionar, la palabra inflamación, neuroinflamación, porque se podría pensar, incluso desde el efecto puramente cognitivo, que alguien que no puede hacer lo que estaba tan acostumbrado a hacer todo el tiempo o durante un período prolongado, ahora está viendo que su vida se vuelve tan limitada.

 

Pensar en eso en sí mismo va a hacer que uno se sienta muy ansioso y deprimido por no ser capaz de hacer lo que una vez fue capaz de hacer en la vida y profesionalmente, personalmente, lo impacta. En segundo lugar, la inflamación, como he mencionado, la neuroinflamación, y ahora entendemos que la ansiedad y la depresión no son solo producto de la imaginación, esta neuroinflamación subyacente es responsable de estos trastornos.

 

Así que, como amplió el Dr. Mehta, los microcoágulos en el cerebro y la inflamación que está ocurriendo, uno puede pensar que tal vez hay algunos factores subyacentes, que predisponen, que conducen a esta ansiedad y los síntomas depresivos también. Así que es una especie de ida y vuelta, creo, entre esos dos. Ese es el paradigma, sugeriría, que uno afecta al otro.

 

Bill Walsh: Claro, esa es una gran observación. Gracias a los dos. Ahora es el momento de abordar más preguntas de nuestros oyentes con el Dr. Samoon Ahmad y el Dr. Brijesh Mehta. Presionen *3 en cualquier momento en el teclado de su teléfono para conectarse con un miembro del personal de AARP para ponerse en la fila y hacer su pregunta en vivo. Jesse, ¿a quién tenemos ahora en la línea?

 

Jesse Salinas: Sí, nuestra siguiente pregunta proviene de Facebook. Es Lisa, de Virginia, y dice: ¿Qué puedo hacer por mi ser querido que muestra signos de depresión, pero parece negarlo por completo?

 

Bill Walsh: Dr. Ahmad, ¿qué diría usted?

 

Samoon Ahmad: Yo diría que no es inusual. Y la gente tiende a sentir y, muy común, que de alguna manera es una debilidad de mi carácter, debilidad de mi personalidad. Puedo superar esto. No necesito ninguna ayuda. Y creo que lo más importante es simplemente mostrar nuestra presencia y mostrar nuestro amor, mostrar nuestro afecto y ser una persona que escucha o que puede llorar en su hombro, esa presencia constante.

 

Y el simple hecho de estar cerca para ofrecer ayuda, no de forma técnica o profesional, sino simplemente para hablar y entablar algunas conversaciones, hacer que la otra persona se sienta cómoda. Eso en sí mismo puede hacer que la gente no se sienta juzgada. La gente no siente que la estamos obligando a entrar en una situación determinada. Y a veces incluso es útil compartir una vivencia personal o una historia sobre cómo ha luchado uno en la vida en algún momento de la conversación y cómo se ha enfrentado a ello y lo difícil que fue para uno mismo y cómo lo superó.

 

Y así la otra persona no se siente señalada, no se siente criticada, no ve que es única y la única que lucha y sufre en esto. Y ese tipo de compromiso y conversación abierta puede ser muy útil para la persona, a no ser que vea que esa persona es incapaz de atender sus necesidades o que está mostrando síntomas que pueden ser potencialmente peligrosos, algún pensamiento suicida o algo así, entonces obviamente eso es preocupante y puede ser conveniente ponerse en contacto con alguien o pedir ayuda en ese momento.

 

Bill Walsh: Gracias por eso, Dr. Ahmad. Jesse, ¿a quién tenemos ahora?

 

Jesse Salinas: La siguiente pregunta es Jean, en Misuri.

 

Bill Walsh: Hola Jean, bienvenida a nuestro programa. Adelante con su pregunta.

Jean: Sí, mi pregunta es, usted habló hace poco sobre los antivirales, molnupiravir y Paxlovid, para los cuales definitivamente calificaría. Pero yo vivo en un pueblo en el sureste de Misuri que tiene unas 40,000 personas, pero ni siquiera los farmacéuticos parecen saber de lo que estoy hablando. Les he preguntado a mis médicos que dicen que no tienen ninguna autoridad para recetarlos, y la gente con la que hablé no sabe nada al respecto. ¿Qué podemos hacer para conseguirlos? Parece ser una gran oportunidad para que la gente pueda acceder a ellos.

 

Bill Walsh: Sí. Buena pregunta, Jean. Preguntémosle al Dr. Mehta.

 

Brijesh Mehta: Sí, una pregunta fantástica. Lamento que tenga algunos problemas para conseguir este medicamento. Sabe, ciertamente, a pesar de la aprobación de la FDA, la implementación no ha sido tan eficiente como nos hubiese gustado. Y se ha reportado que ha habido excedentes de estos medicamentos antivirales, a pesar de su disponibilidad.

 

Y parte de esto es como usted dijo, acceso, y solo tenemos que hacer un mejor trabajo para transmitir el mensaje a nuestros proveedores de atención médica, especialmente a los guardianes, al médico de atención primaria, así como a las clínicas de atención de urgencia, para garantizar que los pacientes que pueden estar potencialmente infectados con COVID-19, o en categoría de alto riesgo, tengan acceso a este medicamento.

 

También están los sitios web del Gobierno en los que puede buscar información sobre en qué parte de su comunidad están disponibles actualmente estos medicamentos. Y eso se puede proporcionar a través de los CDC. Y si simplemente busca en Google antivirales para la COVID-19, tendrá acceso a algunos de esos recursos dentro de su ciudad.

 

Bill Walsh: Bien, muchas gracias, Dr. Mehta. Jesse, ¿de quién es nuestra próxima llamada?

 

Jesse Salinas: Nuestra próxima pregunta es de Martha, en Minnesota.

 

Bill Walsh: Hola, Martha, bienvenida a nuestro programa. Adelante con su pregunta.

Martha: Ah, sí, hola. Tuve lo que se suponía que era COVID-19 en marzo del 2020. Y no me hice una prueba ni nada porque estaba bien. Pero después de eso, tuve una constelación de síntomas que iban desde confusión mental hasta ardor en la piel y otros tipos de neuropatías y cosas por el estilo.

 

Y ninguna de las pruebas que me hicieron reveló nada. Han pasado tres años. Después de un año y medio, comencé a sentirme mejor, y luego tuve lo que podría ser una gripe o un resfriado o algo así, y luego volvieron todos los síntomas. Entonces me falta el aire, estoy fatigada, olvido cosas, mucha depresión, ansiedad y la verdad es que quisiera saber si realmente, si hay algo que se está haciendo o si hay algún avance con respecto a cómo terminar realmente con toda esta constelación de síntomas.

 

Bill Walsh: Bien. De acuerdo, Martha, muchas gracias, y escucho su respiración dificultosa. Así que tómese un momento para relajarse y escuchemos lo que dicen nuestros expertos. Dr. Mehta, ¿puede ofrecer algún consejo para ayudar a Martha y otras personas en su situación?

 

Brijesh Mehta: Hola, Martha, lamento que esté experimentando estos síntomas, ciertamente no es raro, y no está sola en lo que está pasando. Desafortunadamente, muchos de los pacientes que hemos visto aquí en el sur de Florida y lo que se ha informado en la literatura están experimentando, entre un 30 y un 40%, síntomas prolongados de COVID-19, similares a la constelación de los síntomas que está describiendo.

 

Y el consejo es manejar cada uno de esos síntomas, ya sea con asesoramiento, especialmente si está relacionado con la depresión y la ansiedad, por medio de lo que acaba de explicar el Dr. Ahmad, así como si se trata de problemas de neuropatía, o mialgias, cualquier problema cardíaco o respiratorio, para que se evalúen en consecuencia. Porque no existe ningún tipo de cura que aborde todos estos síntomas.

 

Ciertamente desearíamos que la hubiera, pero en este momento, es síntoma por síntoma. Y así, sin duda la animo a buscar atención médica, especialmente si tiene dificultad para respirar. Y para algunas de las neuropatías que describió, hay medicamentos disponibles en el mercado para tratar esos síntomas, la neuropatía, porque los diabéticos y otros afectados después de un derrame cerebral muchas veces tienen sensaciones dolorosas de hormigueo en los brazos y las piernas, y seguro que se beneficiará de ello.

 

Bill Walsh: Dr. Mehta, usted escuchó su dificultad para respirar, ¿debería recibir tratamiento para eso de inmediato?

 

Brijesh Mehta: Absolutamente. Si tiene un medidor de pulso en casa, sin duda puede comprobarlo, especialmente cuando se siente muy sintomática y le falta el aire, también está disponible en las farmacias locales. Pero si simplemente no siente que puede recuperar el aliento, incluso después de caminar un par de pasos o hablar, entonces acuda a la sala de urgencias o emergencias más cercana.

 

Bill Walsh: Sí. Bueno. Gracias. Dr. Mehta. Cuídese, Martha. Tomemos otra pregunta. Jesse, ¿quién sigue?

 

Jesse Salinas: Sí, traeremos a Ingrid, de Illinois.

 

Bill Walsh: Hola, Ingrid, bienvenida a nuestro programa. Adelante con su pregunta.

 

Ingrid: Sí, me preguntaba, ¿cuánta actividad al aire libre es demasiada? ¿Y cómo puedo manejar emociones dañinas, como la ira? ¿Y cómo contribuiría eso a que me diera un derrame cerebral? Como estoy enojada la mayor parte del tiempo y no quiero estarlo, ¿cómo puedo tomar medidas para no sentirme así?

 

Bill Walsh: Sí, la entiendo. Gracias, Ingrid. Dr. Ahmad, ¿quiere opinar sobre eso?

 

Samoon Ahmad: Puedo opinar. Parte de la pregunta, absolutamente, es que creo que tiene mucha razón, en el sentido de la ira, las emociones y la disidencia. ¿Pueden de alguna manera provocar algún problema físico? Absolutamente. Porque sabemos que la gente que, no quiero lastimar a nadie por etiquetar, pero las llamaremos personalidad tipo A, personas que están muy estresadas y se sienten enojadas y están siempre en movimiento, son más propensas a tener problemas cardíacos.

 

Y como había mencionado antes, que es todo el ciclo de la respuesta al estrés, el sistema de respuesta al miedo en el organismo, que nos pone en este tipo de situación, como un gato con las patas y los pelos de punta. Empezamos con ese estado de pánico, ira e irritabilidad y estrés que pone nuestro sistema físico en gran desventaja de provocar muchos problemas cardiovasculares y esto. Entonces, volviendo a cómo eliminar el estrés, eso es fundamentalmente aparte de que si tiene algún problema físico, obviamente necesita abordarlo, pero es extremadamente importante.

 

Y como mencioné, las técnicas de relajación muscular, o escuchar música, hacer jardinería, caminar o leer, o cualquiera de esas actividades, que pueden desconectarla de ese momento en el tiempo, serían extremadamente útiles, o la respiración profunda que había mencionado, que es fundamentalmente uno de los sistemas de control para reducir ese estrés, eso sería esencial. Pero creo que eso es lo que puedo aportar a eso.

 

Bill Walsh: Está bien. Dr. Ahmad, gracias y Dr. Mehta, gracias también por responder todas nuestras preguntas. Ha sido una discusión muy informativa. Y gracias a nuestros socios, voluntarios y oyentes de AARP por participar en nuestro programa de hoy. AARP, una organización de membresía, no partidista y sin fines de lucro, ha estado trabajando para promover la salud y el bienestar de los adultos mayores durante más de 60 años.

 

Ante esta crisis, estamos brindando información y recursos para ayudar a los adultos mayores y a quienes los cuidan a protegerse del virus y prevenir la propagación a otros mientras se cuidan a sí mismos. Todos los recursos a los que se hizo referencia hoy, incluida una grabación del evento de preguntas y respuestas, se podrán encontrar en aarp.org/elcoronavirus a partir de mañana, 6 de mayo.

 

Vayan allí si su pregunta no fue respondida y encontrarán las últimas actualizaciones, así como información creada específicamente para adultos mayores y cuidadores familiares. Y si están buscando asistencia de Medicare durante la COVID-19, visiten shiphelp.org/COVID-19. Repito, shiphelp.org/COVID-19, para encontrar asistencia de Medicare.

 

Esperamos que hayan aprendido algo que pueda ayudarlos a ustedes y a sus seres queridos a mantenerse saludables. Acompáñennos el 9 de junio para participar en otro evento de preguntas y respuestas sobre el coronavirus en vivo. Hasta entonces, gracias y que tengan un buen día. Esto concluye nuestra llamada.

 

Coronavirus: Life Beyond the Pandemic

Listen to a replay of the live event above.

This event addresses how to safely resume normal activities, connect with others, and find joy again. Our experts will discuss the resiliency of older adults and the importance of exercise, healthy eating, stress management, and mental health care.

The experts:

Samoon Ahmad, M.D.
Clinical Professor of Psychiatry, NYU Grossman School of Medicine
Founder, Integrative Center for Wellness
Author, Coping with Covid-19: Medical, Mental and Social Consequences of the Pandemic

Brijesh Mehta, M.D.
Director, Neurointerventional Surgery at Memorial Neuroscience Institute

Resources:


For the latest coronavirus news and advice, go to AARP.org/coronavirus.


Replay previous AARP Coronavirus Tele-Town Halls

  • May 5 - Coronavirus: Life Beyond the Pandemic
  • April 14Coronavirus: Boosters, Testing and Nursing Home Safety
  • March 24Coronavirus: Impact on Older Adults and Looking Ahead
  • March 10Coronavirus: What We’ve Learned and Moving Forward
  • February 24Coronavirus: Current State, What to Expect, and Heart Health
  • February 10 - Coronavirus: Omicron, Vaccines and Mental Wellness
  • January 27 - Coronavirus: Omicron, Looking Ahead, and the Impact on Nursing Homes
  • January 13 - Coronavirus: Staying Safe During Changing Times
  • December 16 - Coronavirus: What You Need to Know About Boosters, Vaccines & Variants
  • December 9 - Coronavirus: Boosters, Vaccines and Your Health
  • November 18 - Coronavirus: Your Questions Answered — Vaccines, Misinformation & Mental Wellness
  • November 4 - Coronavirus: Boosters, Health & Wellness
  • October 21 - Coronavirus: Protecting Your Health & Caring for Loved Ones
  • October 7 - Coronavirus: Boosters, Flu Vaccines and Wellness Visits
  • September 23 - Coronavirus: Delta Variant, Boosters & Self Care
  • September 9 - Coronavirus: Staying Safe, Caring for Loved Ones & New Work Realities
  • August 26 - Coronavirus: Staying Safe, New Work Realities & Managing Finances
  • August 12 - Coronavirus: Staying Safe in Changing Times
  • June 24 - The State of LGBTQ Equality in the COVID Era
  • June 17 - Coronavirus: Vaccines And Staying Safe During “Reopening”
  • June 3 - Coronavirus: Your Health, Finances & Housing
  • May 20 - Coronavirus: Vaccines, Variants and Coping
  • May 6 - Coronavirus: Vaccines, Variants and Coping
  • April 22 - Your Vaccine Questions Answered and Coronavirus: Vaccines and Asian American and Pacific Islanders
  • April 8 - Coronavirus and Latinos: Safety, Protection and Prevention and Vaccines and Caring for Grandkids and Loved Ones
  • April 1 - Coronavirus and The Black Community: Your Vaccine Questions Answered
  • March 25 - Coronavirus: The Stimulus, Taxes and Vaccine
  • March 11 - One Year of the Pandemic and Managing Personal Finances and Taxes
  • February 25 - Coronavirus Vaccines and You
  • February 11 - Coronavirus Vaccines: Your Questions Answered
  • January 28 - Coronavirus: Vaccine Distribution and Protecting Yourself
    & A Virtual World Awaits: Finding Fun, Community and Connections
  • January 14 - Coronavirus: Vaccines, Staying Safe & Coping and Prevention, Vaccines & the Black Community
  • January 7 - Coronavirus: Vaccines, Stimulus & Staying Safe
  • Dec 3 - Coronavirus: Staying Safe & Coping This Winter
  • Nov 19 - Coronavirus: Vaccines, Staying and A Caregiver's Thanksgiving
  • Nov 12 - Coronavirus: Coping and Maintaining Your Well-Being
  • Oct 1 - Coronavirus: Vaccines & Coping During the Pandemic
  • Sept 17 - Coronavirus: Prevention, Treatments, Vaccines & Avoiding Scams
  • Sept 3 - Coronavirus: Your Finances, Health & Family (6 months in)
  • Aug 20 - Your Health and Staying Protected
  • Aug 6 - Coronavirus: Answering Your Most Frequent Questions
  • July 23 - Coronavirus: Navigating the New Normal
  • July 16 - The Health and Financial Security of Latinos
  • July 9 - Coronavirus: Your Most Frequently Asked Questions
  • June 18 and 20 - Strengthening Relationships Over Time and  LGBTQ Non-Discrimination Protections
  • June 11 – Coronavirus: Personal Resilience in the New Normal