AARP Coronavirus Tele Town Halls
AARP Coronavirus Tele-Town Halls
L.J. Tan, M.D., Chief Strategy Officer, Immunization Action Coalition Sam Brooks, Director of Public Policy, The National Consumer Voice for Quality Long-Term Care For the latest coronavirus news and advice, .
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AARP Coronavirus Tele-Town Halls
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, press *0 on your telephone keypad now. (Española) Bill Walsh: AARP, a nonprofit, nonpartisan membership organization has been working to promote the health and well-being of older Americans for more than 60 years. In the face of the global coronavirus pandemic, AARP is providing information and resources to help older adults and those caring for them. While the pandemic has been officially declared over, we aren't out of the woods yet from a health standpoint. New COVID cases and hospitalizations have ticked up slightly as we enter fall and winter, and fewer Americans than ever are getting flu shots in the face of what experts say could be a worse-than-normal flu season. Meantime, in our nursing homes where our most vulnerable loved ones live, only half of staff and residents are up to date on their COVID vaccines. As we prepare to gather with friends and family this holiday season, there are some commonsense steps we can all take to stay healthy and safe and make sure our loved ones are protected as well. Today we're going to hear from an impressive panel of experts about these issues and more. We'll also get an update from Capitol Hill and 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 questions live. For those of you joining us on the phone, if you'd like to ask a question about the coronavirus pandemic, press *3 on your telephone keypad to be connected with an AARP staff member who will note your name and question and place you in a queue to ask that question live. 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 an infectious disease specialist, an immunization expert, and a national nursing home advocate. We'll also be joined by my AARP colleague Jesse Salinas, who will help facilitate your calls today. This event is being recorded and you can access the recording at AARP.org/coronavirus 24 hours after we wrap up. ... Now, I'd like to welcome our guests. Céline Gounder, M.D., is a senior fellow and editor-at-large for public health at the Kaiser Family Foundation. Dr. Gounder is also a clinical associate professor of Medicine and Infectious Diseases at NYU's Grossman School of Medicine, and a CBS News medical contributor. Welcome, Dr. Gounder. Céline Gounder: It's great to be here. Bill Walsh: All right, it's great to have you. We're also joined by L.J. Tan, M.D., chief strategy officer at the Immunization Action Coalition. Welcome back to the program, Dr. Tan. L.J. Tan: Oh, thank you so much. Happy to be back. Bill Walsh: All right, we're happy to have you. And we also have Sam Brooks, who is the director of public policy at the National Consumer Voice for Quality Long-Term Care. Welcome to the program, Sam. Sam Brooks: Great, thanks. Happy to be here. Bill Walsh: Let's get to it. Dr. Gounder, are there indications we'll see another fall or a winter COVID surge, do you expect? Céline Gounder: We anticipate another COVID surge this winter. In 2020 and 2021, we saw big winter surges, and the wonderful thing about the winter holidays is that we get to see family and friends. But those gatherings between Thanksgiving and the New Year have also driven a lot of COVID transmissions. And then on top of that, new COVID variants have emerged again, which means there's less of an immunity wall blocking the spread of the virus, even among people who've been vaccinated or infected in the past. Bill Walsh: Dr. Gounder, let me ask you about the flu. Now, the flu has hit earlier this year and has been more severe at this early stage of the season at any time since 2009. Yet flu vaccination rates are lower than ever. Why is that? And, and given the low rates, how bad could things get? Céline Gounder: Unfortunately, I think we've seen some of the resistance to COVID vaccination and the politicization of vaccines have a spillover effect on other vaccines, including flu shots. And the timing here is really terrible. We had the suppression of any number of respiratory viruses in 2020 and 2021 when people were masking and social distancing. And now those viruses, like flu, like RSV, and so on, are coming back with a vengeance. And then on top of that, hospitals are really, really full. We're still dealing with staffing shortages that were caused by the pandemic. So the best thing you can do is try to stay out of the ER, not by avoiding medical care if you need it, but try not to get sick by getting your flu shot, by getting your COVID shots. Bill Walsh: Yeah, all right, great advice. Dr. Tan, you're an expert in immunization. Let me turn to you for a moment here. You know, this time of year can be really confusing, as Dr. Gounder just said, with an increase in all kinds of respiratory infections. Are there any clear-cut symptoms that distinguish say, a cold from the flu, from COVID? How do people know what they might be experiencing? L.J. Tan: Yeah. Well, glad to be back here, Bill. Thank you very much again. I think the challenge is that as COVID has continued to evolve, and we have seen all these, you know, what we like to call the Scrabble variants pop up. It has become more and more like a cold or an influenza or flu in terms of symptoms. And I think it's hard to tell the difference now. Obviously, if you go in, these people can test and can help you identify something between flu and COVID, but in terms of you just looking at yourself and feeling sick with your headache and your fever and your chills, it's getting harder and harder to distinguish them. But what I can say is that there is a vaccine against flu, there is a vaccine against COVID and you, if we get vaccinated, we can take those two, at least in terms of severity of symptoms everything that Dr. Gounder talked about, we can take those off the table, right? We may not be able to take the cold off the table, but we can take flu and COVID off the table. Bill Walsh: Well, let's stay on flu for just a moment. There's been a lot of misinformation out there about the flu, and maybe you can help clear some of that up. I want to take a moment and review some common beliefs about flu and maybe you can just let us know if these are true or false, kind of rapid-fire style. I mean one thing we are hearing all the time is that the flu isn't all that serious. True or false? L.J. Tan: Oh, absolutely false. Hundreds of thousands of hospitalizations, potentially tens of thousands of deaths every flu season — depending obviously on the strain that's circulating. So false, it's not true. Bill Walsh: Healthy adults don't need to take the vaccine. L.J. Tan: Not true at all. Flu does not discriminate between whether you have a high-risk condition or whether you're healthy. It can take you out, if you're lucky, maybe just three to five days out of work. But if you're unlucky, it could be months. Bill Walsh: Another one we hear a lot is you … can get ill from the flu vaccine. L.J. Tan: That is a falsehood. It is not possible to get flu from the flu vaccine because the vaccine comprises inactivated or what we like to call killed elements of the virus. So there's no way the vaccine can give you the flu. Bill Walsh: If you're not vaccinated early, you might as well skip it, is another belief floating around out there. L.J. Tan: Another piece of misinformation. Definitely not true, and this is very relevant for this season because we actually do have an early start to the flu season. The vaccine comprises four different strains of flu virus, so it provides vaccine protection against more than just the strain that you might have gotten sick with. And so definitely it is worthwhile to keep getting vaccinated throughout the flu season as it continues to provide benefits, as it continues to provide protection against hospitalization and disease throughout the flu season. Bill Walsh: Here's another common belief: Flu vaccines aren't effective because people still get the flu. L.J. Tan: Yeah, so many, many reasons for that, why that's not necessarily true. Obviously, flu vaccines protect against the flu, as we've already discussed. There are other diseases that causes similar symptoms that circulate. Those won't get protected by the flu vaccine. So you might get vaccinated against flu and still pick up a cold. Secondly, a lot of people can get flu but what happens is that if you're vaccinated, it will protect you from all the bad side effects from flu like hospitalizations, and, of course, death. Bill Walsh: And finally another common belief we hear oftentimes about the flu is that flu vaccines side effects are risky. L.J. Tan: So not true. Flu vaccines are probably one of the safest vaccines we have. Millions, millions and millions and millions and millions of doses of flu vaccine has been given every season and through the last decades. So we know almost everything we need to know with regards to flu vaccine safety. It is an incredibly, incredibly safe vaccine. Bill Walsh: Hmm, and isn't there a new high-dose flu vaccine for older adults out there? L.J. Tan: There are actually three vaccines that are now recommended for people over 65. I'm going to use the actual name of the vaccine, but this does not imply an endorsement by me of any of these specific brands. Just have to disclaim that. So there is something called Fluzone High Dose, there's something called Fluad, and then there's something called Flublok. Those three vaccines have been recommended for 65 and older by the CDC because they promote a better immune response in those over 65. So yes. Bill Walsh: Very good. Thanks for that, Dr. Tan, really helpful. Dr. Gounder, let me turn back to you and let's shift our focus to COVID. Last week, Pfizer said the newest bivalent COVID vaccine produces four times more antibodies for people over 55 than the original vaccine. What does this mean for older adults, and are the newest vaccines more effective at preventing infection? Céline Gounder: I think we have to be careful about saying that the new boosters are better. They're at least as good as the old ones, but the jury is still out as to whether they're actually more effective in preventing infection. Big picture, they're at least as good, and it's really important, especially if you're 50 and older, that you get your booster before this winter surge. Bill Walsh: And you heard Dr. Tan urging people to get their flu vaccine, too. What do you say to people about getting multiple vaccines at the same time, Dr. Gounder. Céline Gounder: You can absolutely get your flu shot and your COVID shot at the same time. That has been shown to be safe. You may have a little bit more in the way of some of those mild fevers or some achiness afterwards, but studies have also been done recently looking at the use of Tylenol, Ibuprofen, those kinds of over-the-counter pain and fever medications —and those can be used safely to reduce those side effects if you get your flu and COVID shots. Bill Walsh: Okay. Thanks for that, Dr. Gounder. Let's turn to our listeners. It's now time to address your questions about the coronavirus with Dr. Gounder, Dr. Tan, and Sam Brooks. … I'd now like to bring in my AARP colleague Jesse Salinas to help facilitate your calls today. Welcome, Jesse. Jesse Salinas: So glad to be here, Bill. Bill Walsh: All right, Jesse, who do we have first on the line? Jesse Salinas: Our first caller is going to be Shirley from California. Bill Walsh: Hey Shirley. Welcome to our program. Go ahead with your question. Shirley: I'm 81 years old and I wanted, I got all the shots, the Moderna 1, 2, 3, 4, and then I got the booster in April of this year. But just the last couple of days I've had this slight headache, I don't know where it's coming from. Should I go get another shot? Bill Walsh: Dr. Gounder, can you help Shirley with that? Celine Gounder: I think first things first. If you have symptoms, you should get yourself tested. You can either go to a local testing site or get one of those at home rapid tests for COVID. You can also try going to an urgent care center for that. If you have COVID, or for that matter, the flu, there are treatments for both of those. And so you have Paxlovid for COVID, you have Tamiflu for the flu, so if you have those infections, you should be treated. If you don't, you can get vaccinated now. Bill Walsh: Dr. Gounder, Shirley mentioned she was boosted in April. That was quite some time ago. Is she due for another booster at this point, or should she wait some? What is the period of time people should be waiting before they get a booster? Céline Gounder: About three months or so between doses or after your most recent infection. But that said, if she's currently infected, she should hold off until three months after that. But I think the really important thing for Shirley is, if she's sick with COVID right now, if she's sick with the flu right now, address that first, and then once she's done so, to absolutely get that additional COVID booster. Bill Walsh: Very good. Thank you for that, Dr. Gounder. Jesse, who is our next caller? Jesse Salinas: Our next caller is going to be Chris from California. Bill Walsh: Hey, Chris. Welcome to our program. Go ahead with your question. Chris: Hi. My brother is 73. He just tested for COVID. My mother is 95 and she just had surgery. So what I would like to know is how long should we wait before he comes to visit her? Bill Walsh: Hmm, interesting question. Dr. Gounder, can you field that one? Céline Gounder: Sure, there's two different ways to approach this. Either you can use those at-home rapid COVID tests to figure out when your brother is no longer infectious. What you want to do is see him test negative two times, twice in a row, at least one to two days apart. If you do not have tests or can't afford tests, you could also count somewhere between 10 to 14 days after he was initially diagnosed. I would err on the longer side, 14 days, if you're able to before he spends time with your mother and other people. Bill Walsh: All right, and Dr. Gounder, is the federal government still sending free tests to people or is that option still available? Céline Gounder: Insurance companies, including Medicare, will reimburse you for eight tests per month per individual. But unfortunately, there's no more money left for purchasing more of these at-home tests. So … no, the federal government just can't send those out anymore. Bill Walsh: All right, Jesse, who is our next caller? Jesse Salinas: Our next caller is going to be Carl from New York. Bill Walsh: Hey, Carl, welcome to our program. Go ahead with your question. Hey, Carl, welcome to the program. Do you have a question? Sounds like we may have lost Carl. Jesse Salinas: Yep. Let's go to another one. We've got a question from Facebook by somebody named PD (inaudible). "If you're planning to have visitors for Thanksgiving, how far in advance should they take a COVID test? Is it advisable to have them stay overnight for their visit?" Bill Walsh: Hmm, Dr. Tan, do you want to handle that one? L.J. Tan: Yeah, I'm happy to take that. This is a build-off of Dr. Gounder's response. I think before they show up, they should be testing negative with one of those in-home tests that you can get access to … preferably 24 to 48 hours before arrival with two negative tests. I think one of the things to keep in mind, obviously, is that if anyone's symptomatic … then they should definitely hold off on visiting until they have tested themselves as negative for COVID. I think one of the interesting things that has happened as we've come through this is indeed we say, you know, if you've got symptoms, test negative for COVID, and then you can continue. But I think the point of the matter is that if you have symptoms of any sort, really you should consider taking yourself out of some of these activities because of the fact that you could be, if you're not spreading COVID, you could be spreading flu, RSV, right? So I think it's important to kind of broaden the idea that if you're sick, stay home, and of course get vaccinated. And this way we reduce the likelihood that you'll be unable to attend some of these holiday gatherings that we're all looking forward to. Bill Walsh: Thank you very much, Dr. Tan. Jesse, who do we have up next? Jesse Salinas: Our next call is going to be from Mike in Illinois. Bill Walsh: Hey, Mike, welcome to the program. Go ahead with your question. Mike: Hi. I still have to get my … I have had two shots last in 2021 I think, and I never got the third booster. So now they have the fourth booster. Should I just go ahead and get the fourth booster? And then my question on that also would be, I had Moderna for the first two. Is there any difference in effectiveness between Moderna, Pfizer, or the others for the newest booster shot? Bill Walsh: All right, Mike. Let's ask the experts. Dr. Gounder, can you weigh in on that? Is it ever too late to get a booster? Céline Gounder: It is not too late. I wouldn't worry about counting how many doses. If you've gotten at least your first two doses, at this point, we're really just talking about boosting for the season or when there's a new booster available. So absolutely, go out and get your updated booster now and that way you'll be protected for the holidays. Bill Walsh: OK, and Mike's second question had to do with the effectiveness of one versus the other, Moderna versus Pfizer. … Can he mix and match, and is there any difference in effectiveness? Céline Gounder: They're pretty comparable. Moderna is a slightly higher dose than Pfizer. There are some slight differences. Some people also report a little bit more in terms of side effects with Moderna, again, related to that slightly higher dose, but I really wouldn't worry too much about which brand, just whichever one you're able to get your hands on. There's also a newer booster that's recently been approved, Novavax, which is a slightly different technology. It's what we call a protein vaccine. It's a technology that we use for a lot of other vaccines, and that's certainly an option as well. Bill Walsh: And so should people worry about mixing and matching these or should, I think you said they should just take whatever's available to them. Céline Gounder: Yeah, it's absolutely fine to mix and match. Just whatever is available to you and that you're able to get as soon as possible. Bill Walsh: OK, very good. … Jesse, let's go back to the lines. Who do we have up next? Jesse Salinas: We're going to bring in Joan from Indiana. Bill Walsh: Hey, Joan, welcome to our program. Go ahead with your question. Joan: My question is I've got a daughter who's 53 years old, she's never had a flu shot, but she's never had the flu. And her argument is if she's never had the flu, then she shouldn't have to take it. And she claims she's talked to a physician about this, and as long as she takes her vitamins and her other medications, then she should be OK. What's your response to that? Bill Walsh: Let's ask Dr. Tan about that. Doctor, what would you say to Joan and her daughter? L.J. Tan: I think it's a common misperception that if you're healthy and you've never had flu before, you don't need to get protected against the flu. Every single flu season, Joan, is different, and every single flu season that your daughter doesn't get vaccinated, she's essentially gambling with her health because this could be the season where she will actually catch flu — and it could be a really bad flu that she catches that could really hurt her. So I think it's one of those things where I always ask, why are you gambling every season? We have a good, safe, effective vaccine. If you get the vaccine, you can guarantee yourself that you're not going to have severe consequences from flu. And I don't see why people want to gamble. Every single flu season is different, Joan, and just because you didn't catch it last season does not mean … you'll not catch it this season. Bill Walsh: And Dr. Tan, what are you seeing as it relates to the severity of the flu this season? L.J. Tan: Yeah, so this flu season is a little scary. I actually — just before this town hall — came out of a meeting with CDC. We have dramatic, we have, as Dr. Gounder has already pointed out, our hospitalization rates are higher this flu season than they've ever been for the last 10 flu seasons. So, we are very concerned about that. And then obviously, we have diseases, the disease is surging in so many parts of the country faster than we've ever seen for the last few seasons as well. So I think … there's a perfect confluence here of disease as well as vaccination rates being lower, that's really concerning the CDC and folks like us, like Dr. Gounder and myself. Bill Walsh: And how effective is the flu vaccine this year? L.J. Tan: So we don't have the data right now for this year's flu season, obviously, because we're still going into it. But the great news, again, from this call that I just got off with the CDC, is that the vaccine strain, the virus that's in the vaccine appears to be 92 to a 100 percent matching the strains that are currently circulating. So it looks like we've got a good vaccine this year. Bill Walsh: Hmm. That's great news. All right, thanks, Dr. Tan, for that. Let's take another call, Jesse. Jesse Salinas: We're going to bring on Deborah from North Carolina. Bill Walsh: Hey, Deborah. Welcome to our program. Go ahead with your question. Deborah: Hi. I just wanted to ask the panel their opinion on the use of Evusheld for immunocompromised patients who are fully vaccinated and have both boosters. Bill Walsh: Hmm. Deborah: And it's E-v-u-s-h-e-l-d. Bill Walsh: OK, Dr. Tan, can you address that? L.J. Tan: You know, I'm going to punt that to Dr. Gounder in her expertise as an ID doc. This is obviously the monoclonal antibody treatment, and I think we do know that there's some data that suggests that this monoclonal antibody treatment for COVID may be less effective against some of the subvariants that we are seeing with omicron. But Dr. Gounder, I would rather have you take this as your expertise. Céline Gounder: Sure. And I agree with that. This is one of the concerns that we have about the emerging subvariants that are spreading across the country right now. You may have heard BQ 11, for example. What we … as Dr. Tan referred to as the Scrabble variants with this mix of letters that are hard to decipher. But the problem with these subvariants is that many of them are resistant to all of the monoclonals that we have, all of these treatments — including Evusheld, which is used as a preventative medication for people who are immunocompromised, as Deborah said. And so it makes it all that much more important that people get vaccinated because we have, unfortunately, fewer tools in our arsenal to deal with COVID this winter. Bill Walsh: Right. And so people have the opportunity to prevent it on the front end because we don't have a lot of tools on the back end to manage it, it sounds like. Céline Gounder: Exactly. L.J. Tan: Bill, if I could ... Bill Walsh: Yeah. Go ahead. L.J. Tan: If I could also quickly jump in, because I forgot to mention this when Joan was talking about her daughter, and this is obviously true with COVID too. …When I was emphasizing the answer about protecting herself and not gambling, part of the reason to get vaccinated also is that you don't want to be infecting others. And if you get vaccinated, you can also protect the people around you that you care about. And in this situation, obviously someone who's immunocompromised, if you are vaccinated against COVID, you reduce the risk that you transmit something to someone who's immunocompromised. Bill Walsh: Yeah, it's a great point. And I think people forget that, right? They think of it's about themselves, but they can be carriers too, and they may not even know it. Great point. Let's go back to the lines. Jesse, who's next? Jesse Salinas: Yeah, I'm going to bring on Nancy from Ohio. Bill Walsh: Hey, Nancy, welcome to our program. Go ahead with your question. Nancy: Hi, there. Thank you for your program. One quick question. I'm concerned about the RSV virus in adults. Is it dangerous for somebody 78 years old to be near a baby that has the RSV virus? Bill Walsh: Hmm, great question. Dr. Tan, do you want to field that one? L.J. Tan: Yeah, I'll field that one, and then I will also ask Dr. Gounder to weigh in as well. So RSV has surged and continues to surge in this past month, and I think one of the biggest challenges is that it has dramatically higher impact on young children — in other words, hospitalizing them and potentially also higher rates of death, as well as in adults that are 65 years of age and older. And so, Nancy, that will be right where you are. So indeed, RSV does have more severe impact on older adults, and unfortunately, in older adults, we don't have a treatment for it other than supportive care. In other words, which means taking care of how you feel. So we really would love that if you are taking care of a younger grandchild who has been diagnosed with RSV, we do urge that you have to be especially cautious … and make sure you don't catch it. So that could include yourself wearing a good quality mask, making sure you're sanitizing your hands frequently between touching the child, and obviously, if at all possible, taking some time away when the child is actively in symptoms because that's when they're most infectious. And I understand that's tricky, obviously, because it is the grandchild, you want to be there. So that's kind of what I would advise. Dr. Gounder, do you have anything else to add to that? Céline Gounder: Yeah, what we see with a lot of respiratory infections, whether it's the flu or COVID or RSV, is that it can cause exacerbation or worsening of other underlying chronic medical conditions. So that could be COPD or emphysema. It could be heart disease where people come in with a heart attack. In fact, we've seen as an example the vaccination against the flu can protect you from having a heart attack that's related to having the flu over the winter. And so there are many reasons for older people to really try to avoid getting RSV. It's not just the infection itself, but the way in which it can make other conditions worse. Bill Walsh: Hmm, OK. Thanks for that both Dr. Tan and Dr. Gounder. And thank you, our listeners, for all those great questions. We're going to take more of your questions shortly, but before we do, let's get a quick update from Capitol Hill. In addition to sharing information and resources, AARP advocates at the state and national levels for issues that affect you the most. To give a quick update on how AARP is fighting for you, I wanted to bring in Government Affairs Vice President Megan O'Reilly. Welcome, Megan. Megan O’Reilly: Happy to be here, Bill. Bill Walsh: All right. Happy to have you. Now, I want to ask about a few important issues, but let's start with some really good news. This past August, a historic prescription drug reforms passed the House and Senate were signed into law. Can you tell us a little bit about what this means for people? Megan O’Reilly: Yes, the Prescription and Drug Pricing Reform Law is a huge victory for older Americans. After decades of calling on Congress to make prescription drugs more affordable, AARP won the fight to let Medicare negotiate lower drug prices and for other policies that will save seniors money on their medications. For example, the new law will cap the cost of Medicare-covered insulin at $35 a month starting in January, and eliminates out-of-pocket costs for most vaccines under Medicare, such as the shingles vaccine. Starting in 2025, there will be an annual $2,000 limit on how much Medicare Part D beneficiaries pay out-of-pocket for their prescription medications, and drug makers that increase their prices faster than the rate of inflation will be penalized. These are huge wins. Bill Walsh: Well, that's awesome news. Thanks for that, Megan. Now, in addition to Medicare, Social Security is another top priority for AARP, and there's good news there as well, right? Megan O’Reilly: Yes, Social Security recently announced an 8.7 percent cost-of-living adjustment – the largest COLA increase in 41 years. AARP has fought long and hard to protect Social Security COLA so seniors can keep up with rising prices. This increase will provide much-needed relief to millions of Americans struggling with higher food, health care, and other costs. We're also urging Congress to work together in a bipartisan way to protect and strengthen Social Security for the long term. Bill Walsh: OK, Megan, thanks for that update. I want to take a minute to talk about the current state of COVID in America's nursing homes. For those living and working in skilled nursing facilities, this pandemic is far from over, isn't that right? Megan O’Reilly: Sadly, that's correct, Bill. The AARP Nursing Homes COVID Dashboard shows that transmission in nursing homes remains significantly elevated compared to the rest of the population. One of the most important things people can do is make sure their loved ones are vaccinated and have received the recommended boosters. Nearly half of residents and more than half of staff are not up-to-date with their shots, and this could have deadly consequences as we head into cold and flu season. This is the time to be an advocate for your loved one. Contact your nursing home and ask about vaccination rates and plans to keep residents safe this fall and winter. And if you need help knowing what to ask, go to AARP.org/nursinghomes and see our article, "10 COVID-19 Questions to Ask a Nursing Home." Bill Walsh: OK, that was AARP.org/nursinghomes. That's a terrific story. The 10 questions to ask a nursing home. It's really helpful, and we're updating it regularly. So take a look at that on AARP.org. Thanks so much for being here today, Megan. If our listeners want to get involved with AARP’s advocacy, how can they do it? Megan O’Reilly: Sure, we encourage everyone to go online to AARP.org/getinvolved. That's AARP.org/getinvolved, and sign up to be an e-activist. You'll receive email action alerts with easy ways to make your voice heard, whether on COVID, protecting your hard-earned Social Security and Medicare benefits, and more. Once again, that's AARP.org/getinvolved. It's an easy way to make a big difference. Bill Walsh: All right. Thank you so much, Megan, for that update. Really appreciate your being here today. Let us turn back to our experts. … Dr. Gounder, you recently wrote an article in The Atlantic that said Americans and political leaders lack the moral imagination to solve the COVID crisis, that we needlessly tolerate 150,000 deaths per year, and too often ignore elderly people, people of color, and people with disabilities. Can you share more about your concerns? Céline Gounder: Sure. We're still seeing between 300 and 500 deaths from COVID per day, which translates to 150,000 additional deaths per year in the United States from COVID. And at the same time, we've also seen deaths from COVID shift older. Ninety percent of deaths from COVID are now occurring among people 65 and older, and 40 percent of COVID deaths are now occurring among people 85 and older. So the demographics have really shifted older since the summer of 2021, when it was about 50/50 deaths among people over and under 65. We also know that people of color and people who are immunocompromised or have disabilities are at higher risk for comp … (dogs barking) Sorry, the dogs ... are higher risk for complications from COVID, and unfortunately the vast majority of the American population thinks the pandemic is over and has stopped taking precautions. To prevent transmission, I think we're thinking too narrowly about what we can do to reduce the risk. So yes, masks and vaccines. Vaccines are important, but there are other highly effective tools, too. For example, improving indoor air quality with ventilation and air filtration. For the holidays you can get yourself some portable HEPA air filtration units for your home, put them in places where the family or friends congregate — kitchen, living room, dining room, for example. We should also make a lot more use of COVID testing and treatment, and again, a reminder that if you do test positive for COVID, you can be treated with Paxlovid, which is highly effective in keeping people out of the hospital. And finally, when the public health emergency does come to an end, some people may be losing their Medicaid coverage. Medicaid covers low-income people. Medicare will stay the same, but some people might lose that Medicaid coverage, which can really create hardship for folks who are already struggling to get by. Bill Walsh: Thanks for that, Dr. Gounder, but let's talk a little bit more about some of the tools you mentioned there. We've talked a little bit about the newest vaccines. I wonder how effective they are against the subvariants that you and Dr. Tan have talked about; and also at-home COVID tests. Are they effective in detecting these subvariants? Céline Gounder: The at-home COVID tests still work perfectly well with the new subvariants. Same goes for Paxlovid, the pill that you can take for COVID. Both of those tools still work very well, just as well for the new subvariants. The vaccines may not work as well, and the monoclonal antibodies may not work as well. Where we need to sort of adjust our expectations of vaccines is that the vaccines will keep you out of the hospital. They will prevent you from dying. They may not prevent all infections, and so it's very important that you get vaccinated, but you may still want to be layering other tools like masking, like those HEPA air filtration units, like testing and treatment to further reduce your risk. Bill Walsh: I like that notion of layering on protection. Makes a lot of sense. Dr. Gounder, great effort is being made to understand what causes and alleviates so-called long COVID. This week, in fact, researchers at the US Department of Veterans Affairs said that the antiviral Paxlovid, which you just mentioned, reduces the chances of certain long-COVID conditions by a quarter. Why do some people continue to experience COVID complications and how dangerous are they? Céline Gounder: Well, one thing we have seen is that if you have immunity, if you've been vaccinated, your risk of developing long COVID is lower than if you have not been vaccinated. We don't entirely understand what causes long COVID yet. It's probably a cluster of a number of different syndromes, each of which have a slightly different set of symptoms caused slightly differently, but we know that, again, vaccination will reduce your risk and getting treated with Paxlovid if you are infected does seem to be, at least from the early data, does seem to be protective. It's yet another reason, if you have symptoms to get yourself tested for COVID, so you can get treated and so you're less likely to end up with long COVID. Bill Walsh: OK, very good. Dr. Tan, let me bring you back in. We're beginning to see school closures around the country in response to the flu and the RSV infections. What do grandparents helping care for school-aged grandchildren or great-grandchildren need to know about RSV and flu outbreaks? L.J. Tan: Yeah, thanks Bill. I think to follow up on some of this conversation from earlier, I think if you're taking care of a child that's younger than school age, the first thing, get the flu vaccine because we can take flu off the table. Again, to echo Dr. Gounder's point, it reduces your risk of hospitalization, reduces your risk of death, reduces your risk of severe disease. It may not entirely protect you from getting infected, but it does have strong benefits — and so get vaccinated against flu. Take that off the table. Now, as we've already talked about RSV, we don't have a vaccine for that yet. And, unfortunately, we do want to keep away from getting infected with RSV because of some of the reasons Dr. Gounder had already mentioned, including this idea that it exacerbates or makes worse some of the chronic conditions that older people tend to have — things like, for example, a heart disease; COPD, which is a chronic obstructive pulmonary disease, lung disease, in other words. Diabetes, for example, is another one that we know flu exacerbates as well or makes worse. So we would urge that in the process of taking care of a school-aged child who might have been exposed to an outbreak, that you keep that in mind and take the precautions of layering on infection control things like masking, frequent sanitizing, washing of hands, making sure that the child covers their cough so that if possible at all, you avoid being infected. And, of course, you know, what I would say is if you can avoid getting in contact with someone who's actually symptomatic, that is something you want to do. Bill Walsh: Thanks very much for that, Dr. Tan. Now my colleague, Megan O'Reilly, was talking about some concerns in our nation's nursing homes, particularly the low vaccination rates there. To give us more insights on long-term care facilities, I'd like to bring in Sam Brooks to our conversation. Sam is the director of public policy at the National Consumer Voice for Quality Long-Term Care, a national consumer advocacy group. Sam, welcome to the program. I'd like to ask you … you know nearly one half of long-term care facility residents are not up-to-date with COVID vaccines. What are facilities doing to ensure that residents have access to the newest COVID and flu vaccines, and how are they educating residents? Sam Brooks: Thanks for that question. First, just let me say what a wonderful call this has been and how informative it has been. The statistic that you mentioned is very concerning to us. And it's, unfortunately, not clear just what facilities are doing to ensure that both staff and residents are up- to-date with their boosters. We saw at the beginning when vaccines first became available, there was an all-out effort, really from the government down; there were vaccine clinics, there were partnerships formed with various pharmacies, and you saw a real high uptake of vaccinations in residents. You know, 8 or 9 out of 10 residents had their first primary set of vaccinations. But now you've just seen, not a corresponding effort from the government, when it comes to boosters, and it's very concerning to us. We're hearing from residents — or we're hearing from residents and long-term care ombudsmen, that residents don't understand why they continue to need to get shots. And we really believe, unfortunately, I mean we would hope that most residents could be on a call like this today to see just how important this is. And I know that you know there's 15,000 nursing homes across the United States. Unless we have a concerted effort, really, from the federal government and state governments to say, we need to do some education around this, we're going to see these dismal numbers continue. And going into the fall flu and COVID season, it's very concerning for us. Bill Walsh: Thanks for that, Sam. Now according to October CDC data, long-term care facilities staff and home health care workers have the lowest COVID vaccination rates, lowest COVID booster rates, and lowest flu vaccination rates among health care professionals. Why is this, and where do you turn if you have concerns or need help working with a long-term care facility? Sam Brooks: Again, I was looking at the data. Three out of four nursing home direct care staff aren't up-to-date on their vaccines. The federal government, the Centers for Medicare and Medicaid Services, instituted a mandate that staff be vaccinated. And you saw that … about 9 out of 10 staff got their first primary set of vaccinations. But that's just not true with boosters. And we're concerned, again, that there isn't a concerted effort by the government to say, hey, we're going to update our guidance and require staff to be updated with boosters. And I think this makes both residents and families and their loved ones need to be more hypervigilant when making decisions about nursing homes. Nursing homes, if you go to Care Compare … on medicare.gov, you can see the vaccination rates and the booster rates for each nursing home. But those are the types of questions that you need to be asking facilities when you're thinking about the safety of yourself or a loved one. What are the vaccination rates for staff? What are the plans to get your vaccination rates up for staff and residents? Because there's just a lot of things going on right now that are putting residents at risk. Bill Walsh: Yeah, it sounds like it's really time to be an advocate for your loved ones in those facilities. Thanks so much for that, Sam. We're going to come back with more questions for you shortly. And now it's time to address more of our listener questions. … Jesse, who do we have on the line next? Jesse Salinas: OK, Bill. We have a lot of questions on YouTube, on Facebook, and even in our queue from people who are asking about their confusion with how many shots they should have taken or need to take or have to take before they can get the new booster. So can your experts maybe talk about that? Bill Walsh: Dr. Gounder, can you walk us through that? Céline Gounder: As long as you've had two shots, don't worry about counting shots anymore. Just make sure you get the most up-to-date booster available as they come out. So as long as you've had two shots, at a minimum, you can go out and get the updated bivalent omicron boosters, those new ones that have just come out. Bill Walsh: Very good. Keep it simple. All right, Jesse, who do we have up next? Jesse Salinas: This is from Lana in New York. Bill Walsh: Hey, Lana. welcome to our program. Go ahead with your question. Lana: Hi. I was wondering if it is safe to get the flu vaccine if you have an allergy to eggs, and also if the eggs are contained in the flu vaccine. Bill Walsh: Dr. Tan, do you want to field that one? L.J. Tan: Yes, actually there's been a lot of research on this recently and it is absolutely safe to take the flu vaccine now, even if you have an allergy to eggs. That being said, the CDC does advise that if … you’re known to have a severe allergy to eggs, you should try to get the vaccine in a place where someone can watch you after you get the flu vaccine so that, you know, just in case. There is a vaccine out there … there are several vaccines out there that do not have eggs that you can consider. One is called Flucelvax, and the other one's called Flublok. And Flublok indeed is that same vaccine that's recommended for 65 and older. They do not have egg components that are of concern. Bill Walsh: Hmm. That's interesting. I know for the COVID vaccine, people are urged to wait 15 minutes or so to see if there's an allergic reaction. Is it the same guidance for the flu vaccine? L.J. Tan: Yes, it is. And also to do it in a location where there is obviously access to epinephrine in case there is what we call an anaphylaxis reaction. Bill Walsh: Very good. Thank you so much. Jesse, who do we have up next? Jesse Salinas: Our next question is going to be from Bob in North Dakota. Bill Walsh: Hey Bob, welcome to the program. Go ahead with your question. Bob: Thank you. My question has to do with the flu vaccine. I did receive my flu vaccine earlier in October; however, I was not 65 and so I didn't get the high dose. My wife is immunocompromised, and now I am 65, so I'm wondering if and when I could get the high-dose vaccine later on. Bill Walsh: OK, Dr. Tan, do you have any advice for Bob? L.J. Tan: I can give you the official advice, and then I'm going to give you my personal opinion. And I will caveat that. So officially, you've got your flu vaccine, sir. You don't need another flu vaccine. My personal position on this also is that if you turn 65, you just have to realize that if you get a second flu vaccine, it will not be covered by insurance. It will not be covered by Medicare because you are only allowed one flu vaccine in one season. That being said, there is no safety issue with getting two flu vaccines in the same season if they're separated by more than four weeks. And that's just me speaking as an expert. It is not an endorsed position by anybody. Bill Walsh: Now, you said earlier, Dr. Tan, it seemed that the flu vaccine was pretty effective this season. Does that weigh into this at all since Bob has already gotten that flu vaccine? L.J. Tan: It is the same flu vaccine in terms of the strains that are covered in the vaccine, so that's not the equation here. I think the good news, as I said — when I said earlier, it's about 92 to 100 percent matching, the vaccine is 92 to 100 percent matching what's circulating. So that's a very good thing. However, as Dr. Gounder has already pointed out, we don't have real data on that. I mean, until the season continues to progress and we see how well the vaccine actually works in people, we don't have actual data in terms of how well it's preventing hospitalizations, preventing disease, preventing deaths. Bill Walsh: Got it. OK. Thanks very much for that. Jesse, who do we have up next? Jesse Salinas: The next caller is going to be Dolores in Nevada. Bill Walsh: Hey Dolores, welcome to our program. Go ahead with your question. Dolores: Hi, my question is, excuse me ... Bill Walsh: Are you still with us, Dolores? Dolores: Yes. I waited so long; I can't remember what it was. (chuckles) Jesse Salinas: All right, let's move on, Bill. Bill Walsh: All right. Sorry about that, Dolores. Jesse Salinas: Frances from Oklahoma. Bill Walsh: Hey Frances. Welcome to our program. Go ahead with your question. Frances: Yes. I was just asking about the Tylenol and (inaudible), and I think I got my question answered on that. But anyway, I've got a husband in a nursing home, and they are really good about … I've got power of attorney over him, so they send me letters each year for me to sign for him to get his shots. And I always sign them so they don't have to worry about whether they can give it or not. Bill Walsh: Hmm. Any concern whether you should be signing those or whether those are adequate to make sure that he's getting the shots? Jesse Salinas: I think that's right, Bill. I think we've lost her. Bill Walsh: OK. Sam, do you want to take that? Sam Brooks: Sure, I mean when it comes to getting your vaccinations annually, primarily the facility must … first of all, the facility must make these available to residents. And residents themselves should be able to make those choices. But in instances where residents may not be able to, for instance, because of a cognitive impairment or an inability to communicate for some reason, they need to be talking with guardians or loved ones just to make them aware of what is available. And if you are making those decisions for a loved one that's in a nursing home, you can be proactive. You can call them and ask them, first, when are you offering boosters? What boosters are you offering? And also, what type of treatments are you offering for COVID should my loved one get it? So oftentimes you do have to be a little extra active as we talked about before. I'm glad to hear that this particular facility is sending letters. I imagine that might be true for some, but it's always good; it's never good to assume that that will happen, especially if you're the one making those decisions. But, of course, we always want those decisions to be made by residents themselves when they can — but it's always good to have as many people advocating for that safety as possible for folks in nursing homes. Bill Walsh: OK, thanks so much for that, Sam. And Dolores, who had called us earlier, I believe she was going to ask about the cost of boosters. Dr. Gounder, are the boosters still free and will they always be free? Céline Gounder: The boosters are still free for now. So the federal government has purchased the boosters for this fall and winter season. However, in the future, unless Congress decides to allocate more money, and that's really a decision for Congress to make — Congress allocates funding, and it has the power of the purse string, not the president. So if Congress decides to allocate more funding to purchase more vaccines, we may have free vaccines in the future, but that does not seem to be in the cards right now. Bill Walsh: OK, thanks very much for that. Sam, you were just talking about nursing homes. Let's dig into that a little bit. Last month, the Centers for Medicare and Medicaid Services relaxed nursing home vaccine requirements as long as good faith efforts are being made to achieve compliance. What does this mean for people with families in long-term care facilities? Sam Brooks: Yeah, I'm glad you brought that up. We were very, for lack of a better term, disturbed when we heard about this. If you look at the numbers now, they're dismal. And despite this fact in its announcement that it was going to be relaxing enforcement penalties of the vaccine mandate, they called it a success. And when 3 out of 4 staff aren't up-to-date with their boosters and where only 41 percent of residents are, we don't see that as a success. And we do not see this. It's a sign, as Dr. Tan I think indicated, that it's … sending a false sense of security to residents when we're going into a season here that we really need to protect residents. So we're concerned about that. And we should, for families and residents, they need to be talking to their facilities. I mean, a good faith effort isn't enough. We need to see those numbers raised. And if you're in a facility or your loved one is in a facility that has low vaccination rates, you can call that administrator or call that facility and say, what are your plans to get your staff up? And they need to be providing you with that information. And just another thing around this is at the same time, CDC has relaxed masking guidance in health care settings. And we find this particularly troublesome in nursing homes, saying masking only needs to be done or should be done where community transmission levels are high. And we just think it's particularly, and I'm just speaking for nursing homes here, that this is just a very long, a step in the wrong direction. When again, 3 out of 4 staff are not up-to-date with their vaccines, you need to be hypervigilant about whether that facility is requiring health care staff to wear masks. And we're hearing from a lot of residents that they're not. So there's a couple things here going on that we're really concerned about that are coming out just at the wrong time. And really, as you say, you gotta be on your toes to protect your loved ones. Bill Walsh: Let's, let me dig into that just a little bit. I mean, what kind of rights do families have to advocate on behalf of their loved ones in nursing homes? I know just from past programs people feel it's often opaque. They don't really know what's going on inside the facilities. It kind of depends on facility to facility and management company to management company, but what rights do they have, and do they have any allies on the outside they can turn to for assistance? Sam Brooks: Sure, that's a great question and I think you're absolutely right. Unfortunately, the way the system operates, it can be two facilities — one across the street from each other — operating at very different levels. I think the most important resources oftentimes to residents and families are the Long-Term Care Ombudsman. The Long-Term Care Ombudsman is an office of advocates for residents, and each nursing home has a designated long-term care ombudsman — that number must be provided and displayed visually someplace in the facility. And you can call and express your concern with the ombudsman, and the ombudsman will go out and speak to the resident and also act as an advocate on behalf of the resident. And, in addition to that, they can also talk about what rights residents have because there's lots of rights that residents are afforded, but they often don't hear about from the facility. And the second option is filing a complaint with a state survey agency or a state regulatory agency. And this information also needs to be readily available to residents. If you have a concern that your loved one is not getting access to vaccines or that a facility is not observing or practicing proper infection-control procedures, you need to file those complaints and get people out there to take a look and make sure that residents are protected. So there are resources. You can also go on the website, go to Consumer Voice, theconsumervoice.org, and we have pages and pages of ways to advocate on behalf of residents in nursing homes. Bill Walsh: OK. Theconsumervoice.org. And that long-term care ombudsman program is free, is that correct? Sam Brooks: Oh, of course. Yep, it's free. The numbers, you can access those numbers; if you Google your state and long-term care ombudsman, it should come up. You can also get the information at our website. We have … you can click on the map, and we'll give you all kinds of helpful numbers, and that is a free, confidential service that has nothing to do with the facility. It's not hired by the facilities; they're advocates for you and primarily for residents, and I encourage folks to take advantage of them. Bill Walsh: Just very quickly, how are nursing homes held accountable if they fail to provide adequate care? Sam Brooks: Well, I mean, primarily, the primary mechanism, in theory at least, is that states are supposed to go out and enforce the federal regulations. Unfortunately, we're seeing difficulties with that now, attributable to the pandemic. But facilities can face a variety of penalties — including financial penalties and also being excluded from the Medicare and Medicaid programs. And that's really what most facilities want to avoid. However, we — and I think Megan would agree with me — we need to have stronger enforcement from the federal government around these regulations to ensure that the penalties that are in place, facilities do pay to make sure that residents are safe. Bill Walsh: Sam Brooks, thank you so much, and thanks so much also to Drs. Céline Gounder and L.J. Tan. This has been a really informative discussion. We really appreciate all of our guests for being here and offering their insights today. And thank you, our AARP members, volunteers and listeners for participating in this discussion. AARP, a nonprofit, nonpartisan membership organization has been working to promote the health and well-being of older Americans for more than 60 years. In the face of this crisis, we're providing information and resources to help older adults and those caring for them protect themselves from the virus, prevent its spread to others while taking care of themselves. All of the resources referenced today, including a recording of the Q&A event can be found at AARP.org/coronavirus starting Nov. 11. Go there if your question was not addressed, and you'll find the latest updates as well as information created specifically for older adults and family caregivers. We hope you learned something that can help keep you and your loved ones healthy. Please join us again Dec. 15 for another Tele-Town Hall on COVID-19. Thank you very much and have a great day. This concludes our call.
11/10 Tele-Town Hall Transcript with Timestamps [00:00:00] Bill Walsh: Hello, I am AARP Vice President Bill Walsh, and I want to welcome you to this important discussion about the coronavirus. Before we begin, if you'd like to hear this Telephone Town Hall in Spanish, press *0 on your telephone keypad now. [00:00:15] [Española] [00:00:21] 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. While the pandemic has been officially declared over, we aren't out of the woods yet from a health standpoint. New COVID cases and hospitalizations have ticked up slightly as we enter fall and winter, and fewer Americans than ever are getting flu shots in the face of what experts say could be a worse-than-normal flu season. Meantime, in our nursing homes where our most vulnerable loved ones live, only half of staff and residents are up to date on their COVID vaccines. As we prepare to gather with friends and family this holiday season, there are some commonsense steps we can all take to stay healthy and safe and make sure our loved ones are protected as well. [00:01:25] Today we're going to hear from an impressive panel of experts about these issues and more. We'll also get an update from Capitol Hill and 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 questions live. For those of you joining us on the phone, if you'd like to ask a question about the coronavirus pandemic, press *3 on your telephone keypad to be connected with an AARP staff member who will note your name and question and place you in a queue to ask that question live. And if you're joining on Facebook or YouTube, you can post your question in the comments. [00:02:27] We have some outstanding guests joining us today, including an infectious disease specialist, an immunization expert, and a national nursing home advocate. We'll also be joined by my AARP colleague Jesse Salinas, who will help facilitate your calls today. This event is being recorded and you can access the recording at AARP.org/coronavirus 24 hours after we wrap up. ... Now, I'd like to welcome our guests. Céline Gounder, M.D., is a senior fellow and editor-at-large for public health at the Kaiser Family Foundation. Dr. Gounder is also a clinical associate professor of Medicine and Infectious Diseases at NYU's Grossman School of Medicine, and a CBS News medical contributor. Welcome, Dr. Gounder. [00:03:32] Céline Gounder: It's great to be here. [00:03:34] All right, it's great to have you. We're also joined by L.J. Tan, M.D., chief strategy officer at the Immunization Action Coalition. Welcome back to the program, Dr. Tan. [00:03:47] L.J. Tan: Oh, thank you so much. Happy to be back. [00:03:49] Bill Walsh: All right, we're happy to have you. And we also have Sam Brooks, who is the director of public policy at the National Consumer Voice for Quality Long-Term Care. Welcome to the program, Sam. [00:04:01] Sam Brooks: Great, thanks. Happy to be here. [00:04:16] Bill Walsh: Let's get to it. Dr. Gounder, are there indications we'll see another fall or a winter COVID surge, do you expect? [00:04:24] Céline Gounder: We anticipate another COVID surge this winter. In 2020 and 2021, we saw big winter surges, and the wonderful thing about the winter holidays is that we get to see family and friends. But those gatherings between Thanksgiving and the New Year have also driven a lot of COVID transmissions. And then on top of that, new COVID variants have emerged again, which means there's less of an immunity wall blocking the spread of the virus, even among people who've been vaccinated or infected in the past. [00:04:54] Dr. Gounder, let me ask you about the flu. Now, the flu has hit earlier this year and has been more severe at this early stage of the season at any time since 2009. Yet flu vaccination rates are lower than ever. Why is that? And, and given the low rates, how bad could things get? [00:05:14] Céline Gounder: Unfortunately, I think we've seen some of the resistance to COVID vaccination and the politicization of vaccines have a spillover effect on other vaccines, including flu shots. And the timing here is really terrible. We had the suppression of any number of respiratory viruses in 2020 and 2021 when people were masking and social distancing. And now those viruses, like flu, like RSV, and so on, are coming back with a vengeance. And then on top of that, hospitals are really, really full. We're still dealing with staffing shortages that were caused by the pandemic. So the best thing you can do is try to stay out of the ER, not by avoiding medical care if you need it, but try not to get sick by getting your flu shot, by getting your COVID shots. [00:06:02] Yeah, all right, great advice. Dr. Tan, you're an expert in immunization. Let me turn to you for a moment here. You know, this time of year can be really confusing, as Dr. Gounder just said, with an increase in all kinds of respiratory infections. Are there any clear-cut symptoms that distinguish say, a cold from the flu, from COVID? How do people know what they might be experiencing? [00:06:26] L.J. Tan: Yeah. Well, glad to be back here, Bill. Thank you very much again. I think the challenge is that as COVID has continued to evolve, and we have seen all these, you know, what we like to call the Scrabble variants pop up. It has become more and more like a cold or an influenza or flu in terms of symptoms. And I think it's hard to tell the difference now. Obviously, if you go in, these people can test and can help you identify something between flu and COVID, but in terms of you just looking at yourself and feeling sick with your headache and your fever and your chills, it's getting harder and harder to distinguish them. But what I can say is that there is a vaccine against flu, there is a vaccine against COVID and you, if we get vaccinated, we can take those two, at least in terms of severity of symptoms everything that Dr. Gounder talked about, we can take those off the table, right? We may not be able to take the cold off the table, but we can take flu and COVID off the table. [00:07:20] Bill Walsh: Well, let's stay on flu for just a moment. There's been a lot of misinformation out there about the flu, and maybe you can help clear some of that up. I want to take a moment and review some common beliefs about flu and maybe you can just let us know if these are true or false, kind of rapid-fire style. I mean one thing we are hearing all the time is that the flu isn't all that serious. True or false? [00:07:41] L.J. Tan: Oh, absolutely false. Hundreds of thousands of hospitalizations, potentially tens of thousands of deaths every flu season — depending obviously on the strain that's circulating. So false, it's not true. [00:07:51] Bill Walsh: Healthy adults don't need to take the vaccine. [00:07:56] L.J. Tan: Not true at all. Flu does not discriminate between whether you have a high-risk condition or whether you're healthy. It can take you out, if you're lucky, maybe just three to five days out of work. But if you're unlucky, it could be months. [00:08:11] Bill Walsh: Another one we hear a lot is you … can get ill from the flu vaccine. [00:08:17] L.J. Tan: That is a falsehood. It is not possible to get flu from the flu vaccine because the vaccine comprises inactivated or what we like to call killed elements of the virus. So there's no way the vaccine can give you the flu. [00:08:31] Bill Walsh: If you're not vaccinated early, you might as well skip it, is another belief floating around out there. [00:08:38] L.J. Tan: Another piece of misinformation. Definitely not true, and this is very relevant for this season because we actually do have an early start to the flu season. The vaccine comprises four different strains of flu virus, so it provides vaccine protection against more than just the strain that you might have gotten sick with. And so definitely it is worthwhile to keep getting vaccinated throughout the flu season as it continues to provide benefits, as it continues to provide protection against hospitalization and disease throughout the flu season. [00:09:10] Bill Walsh: Here's another common belief: Flu vaccines aren't effective because people still get the flu. [00:09:16] L.J. Tan: Yeah, so many, many reasons for that, why that's not necessarily true. Obviously, flu vaccines protect against the flu, as we've already discussed. There are other diseases that causes similar symptoms that circulate. Those won't get protected by the flu vaccine. So you might get vaccinated against flu and still pick up a cold. Secondly, a lot of people can get flu but what happens is that if you're vaccinated, it will protect you from all the bad side effects from flu like hospitalizations, and, of course, death. [00:09:46] Bill Walsh: And finally another common belief we hear oftentimes about the flu is that flu vaccines side effects are risky. [00:09:56] L.J. Tan: So not true. Flu vaccines are probably one of the safest vaccines we have. Millions, millions and millions and millions and millions of doses of flu vaccine has been given every season and through the last decades. So we know almost everything we need to know with regards to flu vaccine safety. It is an incredibly, incredibly safe vaccine. [00:10:17] Bill Walsh: Hmm, and isn't there a new high-dose flu vaccine for older adults out there? [00:10:24] L.J. Tan: There are actually three vaccines that are now recommended for people over 65. I'm going to use the actual name of the vaccine, but this does not imply an endorsement by me of any of these specific brands. Just have to disclaim that. So there is something called Fluzone High Dose, there's something called Fluad, and then there's something called Flublok. Those three vaccines have been recommended for 65 and older by the CDC because they promote a better immune response in those over 65. So yes. [00:10:54] Bill Walsh: Very good. Thanks for that, Dr. Tan, really helpful. Dr. Gounder, let me turn back to you and let's shift our focus to COVID. Last week, Pfizer said the newest bivalent COVID vaccine produces four times more antibodies for people over 55 than the original vaccine. What does this mean for older adults, and are the newest vaccines more effective at preventing infection? [00:11:17] Céline Gounder: I think we have to be careful about saying that the new boosters are better. They're at least as good as the old ones, but the jury is still out as to whether they're actually more effective in preventing infection. Big picture, they're at least as good, and it's really important, especially if you're 50 and older, that you get your booster before this winter surge. [00:11:39] And you heard Dr. Tan urging people to get their flu vaccine, too. What do you say to people about getting multiple vaccines at the same time, Dr. Gounder. [00:11:48] Céline Gounder: You can absolutely get your flu shot and your COVID shot at the same time. That has been shown to be safe. You may have a little bit more in the way of some of those mild fevers or some achiness afterwards, but studies have also been done recently looking at the use of Tylenol, Ibuprofen, those kinds of over-the-counter pain and fever medications —and those can be used safely to reduce those side effects if you get your flu and COVID shots. [00:12:17] Okay. Thanks for that, Dr. Gounder. Let's turn to our listeners. It's now time to address your questions about the coronavirus with Dr. Gounder, Dr. Tan, and Sam Brooks. … I'd now like to bring in my AARP colleague Jesse Salinas to help facilitate your calls today. Welcome, Jesse. [00:12:56] Jesse Salinas: So glad to be here, Bill. [00:12:57] Bill Walsh: All right, Jesse, who do we have first on the line? [00:13:01] Jesse Salinas: Our first caller is going to be Shirley from California. [00:13:04] Bill Walsh: Hey Shirley. Welcome to our program. Go ahead with your question. [00:13:15] Shirley: I'm 81 years old and I wanted, I got all the shots, the Moderna 1, 2, 3, 4, and then I got the booster in April of this year. But just the last couple of days I've had this slight headache, I don't know where it's coming from. Should I go get another shot? [00:13:39] Bill Walsh: Dr. Gounder, can you help Shirley with that? [00:13:41] Celine Gounder: I think first things first. If you have symptoms, you should get yourself tested. You can either go to a local testing site or get one of those at home rapid tests for COVID. You can also try going to an urgent care center for that. If you have COVID, or for that matter, the flu, there are treatments for both of those. And so you have Paxlovid for COVID, you have Tamiflu for the flu, so if you have those infections, you should be treated. If you don't, you can get vaccinated now. [00:14:14] Bill Walsh: Dr. Gounder, Shirley mentioned she was boosted in April. That was quite some time ago. Is she due for another booster at this point, or should she wait some? What is the period of time people should be waiting before they get a booster? [00:14:31] Céline Gounder: About three months or so between doses or after your most recent infection. But that said, if she's currently infected, she should hold off until three months after that. But I think the really important thing for Shirley is, if she's sick with COVID right now, if she's sick with the flu right now, address that first, and then once she's done so, to absolutely get that additional COVID booster. [00:14:59] Very good. Thank you for that, Dr. Gounder. Jesse, who is our next caller? [00:15:03] Jesse Salinas: Our next caller is going to be Chris from California. [00:15:06] Bill Walsh: Hey, Chris. Welcome to our program. Go ahead with your question. [00:15:09] Chris: Hi. My brother is 73. He just tested for COVID. My mother is 95 and she just had surgery. So what I would like to know is how long should we wait before he comes to visit her? [00:15:28] Bill Walsh: Hmm, interesting question. Dr. Gounder, can you field that one? [00:15:32] Céline Gounder: Sure, there's two different ways to approach this. Either you can use those at-home rapid COVID tests to figure out when your brother is no longer infectious. What you want to do is see him test negative two times, twice in a row, at least one to two days apart. If you do not have tests or can't afford tests, you could also count somewhere between 10 to 14 days after he was initially diagnosed. I would err on the longer side, 14 days, if you're able to before he spends time with your mother and other people. [00:16:11] All right, and Dr. Gounder, is the federal government still sending free tests to people or is that option still available? [00:16:18] Céline Gounder: Insurance companies, including Medicare, will reimburse you for eight tests per month per individual. But unfortunately, there's no more money left for purchasing more of these at-home tests. So … no, the federal government just can't send those out anymore. [00:16:39] All right, Jesse, who is our next caller? [00:16:43] Jesse Salinas: Our next caller is going to be Carl from New York. [00:16:47] Bill Walsh: Hey, Carl, welcome to our program. Go ahead with your question. Hey, Carl, welcome to the program. Do you have a question? Sounds like we may have lost Carl. [00:17:04] Jesse Salinas: Yep. Let's go to another one. We've got a question from Facebook by somebody named PD [inaudible]. "If you're planning to have visitors for Thanksgiving, how far in advance should they take a COVID test? Is it advisable to have them stay overnight for their visit?" [00:17:16] Bill Walsh: Hmm, Dr. Tan, do you want to handle that one? [00:17:19] L.J. Tan: Yeah, I'm happy to take that. This is a build-off of Dr. Gounder's response. I think before they show up, they should be testing negative with one of those in-home tests that you can get access to … preferably 24 to 48 hours before arrival with two negative tests. I think one of the things to keep in mind, obviously, is that if anyone's symptomatic … then they should definitely hold off on visiting until they have tested themselves as negative for COVID. I think one of the interesting things that has happened as we've come through this is indeed we say, you know, if you've got symptoms, test negative for COVID, and then you can continue. But I think the point of the matter is that if you have symptoms of any sort, really you should consider taking yourself out of some of these activities because of the fact that you could be, if you're not spreading COVID, you could be spreading flu, RSV, right? So I think it's important to kind of broaden the idea that if you're sick, stay home, and of course get vaccinated. And this way we reduce the likelihood that you'll be unable to attend some of these holiday gatherings that we're all looking forward to. [00:18:22] Bill Walsh: Thank you very much, Dr. Tan. Jesse, who do we have up next? [00:18:26] Jesse Salinas: Our next call is going to be from Mike in Illinois. [00:18:30] Bill Walsh: Hey, Mike, welcome to the program. Go ahead with your question. [00:18:34] Mike: Hi. I still have to get my … I have had two shots last in 2021 I think, and I never got the third booster. So now they have the fourth booster. Should I just go ahead and get the fourth booster? And then my question on that also would be, I had Moderna for the first two. Is there any difference in effectiveness between Moderna, Pfizer, or the others for the newest booster shot? [00:19:09] Bill Walsh: All right, Mike. Let's ask the experts. Dr. Gounder, can you weigh in on that? Is it ever too late to get a booster? [00:19:15] Céline Gounder: It is not too late. I wouldn't worry about counting how many doses. If you've gotten at least your first two doses, at this point, we're really just talking about boosting for the season or when there's a new booster available. So absolutely, go out and get your updated booster now and that way you'll be protected for the holidays. [00:19:37] OK, and Mike's second question had to do with the effectiveness of one versus the other, Moderna versus Pfizer. … Can he mix and match, and is there any difference in effectiveness? [00:19:47] Céline Gounder: They're pretty comparable. Moderna is a slightly higher dose than Pfizer. There are some slight differences. Some people also report a little bit more in terms of side effects with Moderna, again, related to that slightly higher dose, but I really wouldn't worry too much about which brand, just whichever one you're able to get your hands on. There's also a newer booster that's recently been approved, Novavax, which is a slightly different technology. It's what we call a protein vaccine. It's a technology that we use for a lot of other vaccines, and that's certainly an option as well. [00:20:27] And so should people worry about mixing and matching these or should, I think you said they should just take whatever's available to them. [00:20:34] Céline Gounder: Yeah, it's absolutely fine to mix and match. Just whatever is available to you and that you're able to get as soon as possible. [00:20:41] OK, very good. … Jesse, let's go back to the lines. Who do we have up next? [00:20:55] Jesse Salinas: We're going to bring in Joan from Indiana. [00:20:57] Bill Walsh: Hey, Joan, welcome to our program. Go ahead with your question. [00:21:01] Joan: My question is I've got a daughter who's 53 years old, she's never had a flu shot, but she's never had the flu. And her argument is if she's never had the flu, then she shouldn't have to take it. And she claims she's talked to a physician about this, and as long as she takes her vitamins and her other medications, then she should be OK. What's your response to that? [00:21:27] Bill Walsh: Let's ask Dr. Tan about that. Doctor, what would you say to Joan and her daughter? [00:21:32] L.J. Tan: I think it's a common misperception that if you're healthy and you've never had flu before, you don't need to get protected against the flu. Every single flu season, Joan, is different, and every single flu season that your daughter doesn't get vaccinated, she's essentially gambling with her health because this could be the season where she will actually catch flu — and it could be a really bad flu that she catches that could really hurt her. So I think it's one of those things where I always ask, why are you gambling every season? We have a good, safe, effective vaccine. If you get the vaccine, you can guarantee yourself that you're not going to have severe consequences from flu. And I don't see why people want to gamble. Every single flu season is different, Joan, and just because you didn't catch it last season does not mean … you'll not catch it this season. [00:22:22] Bill Walsh: And Dr. Tan, what are you seeing as it relates to the severity of the flu this season? [00:22:29] L.J. Tan: Yeah, so this flu season is a little scary. I actually — just before this town hall — came out of a meeting with CDC. We have dramatic, we have, as Dr. Gounder has already pointed out, our hospitalization rates are higher this flu season than they've ever been for the last 10 flu seasons. So, we are very concerned about that. And then obviously, we have diseases, the disease is surging in so many parts of the country faster than we've ever seen for the last few seasons as well. So I think … there's a perfect confluence here of disease as well as vaccination rates being lower, that's really concerning the CDC and folks like us, like Dr. Gounder and myself. [00:23:11] Bill Walsh: And how effective is the flu vaccine this year? [00:23:14] L.J. Tan: So we don't have the data right now for this year's flu season, obviously, because we're still going into it. But the great news, again, from this call that I just got off with the CDC, is that the vaccine strain, the virus that's in the vaccine appears to be 92 to a 100 percent matching the strains that are currently circulating. So it looks like we've got a good vaccine this year. [00:23:37] Bill Walsh: Hmm. That's great news. All right, thanks, Dr. Tan, for that. Let's take another call, Jesse. [00:23:43] Jesse Salinas: We're going to bring on Deborah from North Carolina. [00:23:46] Bill Walsh: Hey, Deborah. Welcome to our program. Go ahead with your question. [00:23:50] Deborah: Hi. I just wanted to ask the panel their opinion on the use of Evusheld for immunocompromised patients who are fully vaccinated and have both boosters. [00:24:01] Bill Walsh: Hmm. [00:24:02] Deborah: And it's E-v-u-s-h-e-l-d. [00:24:07] Bill Walsh: OK, Dr. Tan, can you address that? [00:24:10] L.J. Tan: You know, I'm going to punt that to Dr. Gounder in her expertise as an ID doc. This is obviously the monoclonal antibody treatment, and I think we do know that there's some data that suggests that this monoclonal antibody treatment for COVID may be less effective against some of the subvariants that we are seeing with omicron. But Dr. Gounder, I would rather have you take this as your expertise. [00:24:31] Céline Gounder: Sure. And I agree with that. This is one of the concerns that we have about the emerging subvariants that are spreading across the country right now. You may have heard BQ 11, for example. What we … as Dr. Tan referred to as the Scrabble variants with this mix of letters that are hard to decipher. But the problem with these subvariants is that many of them are resistant to all of the monoclonals that we have, all of these treatments — including Evusheld, which is used as a preventative medication for people who are immunocompromised, as Deborah said. And so it makes it all that much more important that people get vaccinated because we have, unfortunately, fewer tools in our arsenal to deal with COVID this winter. [00:25:21] Bill Walsh: Right. And so people have the opportunity to prevent it on the front end because we don't have a lot of tools on the back end to manage it, it sounds like. [00:25:28] Céline Gounder: Exactly. [00:25:29] L.J. Tan: Bill, if I could ... [00:25:30] Bill Walsh: Yeah. Go ahead. [00:25:30] L.J. Tan: If I could also quickly jump in, because I forgot to mention this when Joan was talking about her daughter, and this is obviously true with COVID too. …When I was emphasizing the answer about protecting herself and not gambling, part of the reason to get vaccinated also is that you don't want to be infecting others. And if you get vaccinated, you can also protect the people around you that you care about. And in this situation, obviously someone who's immunocompromised, if you are vaccinated against COVID, you reduce the risk that you transmit something to someone who's immunocompromised. [00:25:58] Bill Walsh: Yeah, it's a great point. And I think people forget that, right? They think of it's about themselves, but they can be carriers too, and they may not even know it. Great point. Let's go back to the lines. Jesse, who's next? [00:26:09] Jesse Salinas: Yeah, I'm going to bring on Nancy from Ohio. [00:26:12] Bill Walsh: Hey, Nancy, welcome to our program. Go ahead with your question. [00:26:15] Nancy: Hi, there. Thank you for your program. One quick question. I'm concerned about the RSV virus in adults. Is it dangerous for somebody 78 years old to be near a baby that has the RSV virus? [00:26:28] Bill Walsh: Hmm, great question. Dr. Tan, do you want to field that one? [00:26:32] L.J. Tan: Yeah, I'll field that one, and then I will also ask Dr. Gounder to weigh in as well. So RSV has surged and continues to surge in this past month, and I think one of the biggest challenges is that it has dramatically higher impact on young children — in other words, hospitalizing them and potentially also higher rates of death, as well as in adults that are 65 years of age and older. And so, Nancy, that will be right where you are. So indeed, RSV does have more severe impact on older adults, and unfortunately, in older adults, we don't have a treatment for it other than supportive care. In other words, which means taking care of how you feel. So we really would love that if you are taking care of a younger grandchild who has been diagnosed with RSV, we do urge that you have to be especially cautious … and make sure you don't catch it. So that could include yourself wearing a good quality mask, making sure you're sanitizing your hands frequently between touching the child, and obviously, if at all possible, taking some time away when the child is actively in symptoms because that's when they're most infectious. And I understand that's tricky, obviously, because it is the grandchild, you want to be there. So that's kind of what I would advise. Dr. Gounder, do you have anything else to add to that? [00:27:45] Céline Gounder: Yeah, what we see with a lot of respiratory infections, whether it's the flu or COVID or RSV, is that it can cause exacerbation or worsening of other underlying chronic medical conditions. So that could be COPD or emphysema. It could be heart disease where people come in with a heart attack. In fact, we've seen as an example the vaccination against the flu can protect you from having a heart attack that's related to having the flu over the winter. And so there are many reasons for older people to really try to avoid getting RSV. It's not just the infection itself, but the way in which it can make other conditions worse. [00:28:27] Bill Walsh: Hmm, OK. Thanks for that both Dr. Tan and Dr. Gounder. And thank you, our listeners, for all those great questions. We're going to take more of your questions shortly, but before we do, let's get a quick update from Capitol Hill. In addition to sharing information and resources, AARP advocates at the state and national levels for issues that affect you the most. To give a quick update on how AARP is fighting for you, I wanted to bring in Government Affairs Vice President Megan O'Reilly. Welcome, Megan. [00:28:59] Megan O’Reilly: Happy to be here, Bill. [00:29:00] All right. Happy to have you. Now, I want to ask about a few important issues, but let's start with some really good news. This past August, a historic prescription drug reforms passed the House and Senate were signed into law. Can you tell us a little bit about what this means for people? [00:29:16] Megan O’Reilly: Yes, the Prescription and Drug Pricing Reform Law is a huge victory for older Americans. After decades of calling on Congress to make prescription drugs more affordable, AARP won the fight to let Medicare negotiate lower drug prices and for other policies that will save seniors money on their medications. For example, the new law will cap the cost of Medicare-covered insulin at $35 a month starting in January, and eliminates out-of-pocket costs for most vaccines under Medicare, such as the shingles vaccine. Starting in 2025, there will be an annual $2,000 limit on how much Medicare Part D beneficiaries pay out-of-pocket for their prescription medications, and drug makers that increase their prices faster than the rate of inflation will be penalized. These are huge wins. [00:30:06] Well, that's awesome news. Thanks for that, Megan. Now, in addition to Medicare, Social Security is another top priority for AARP, and there's good news there as well, right? [00:30:15] Megan O’Reilly: Yes, Social Security recently announced an 8.7 percent cost-of-living adjustment – the largest COLA increase in 41 years. AARP has fought long and hard to protect Social Security COLA so seniors can keep up with rising prices. This increase will provide much-needed relief to millions of Americans struggling with higher food, health care, and other costs. We're also urging Congress to work together in a bipartisan way to protect and strengthen Social Security for the long term. [00:30:47] OK, Megan, thanks for that update. I want to take a minute to talk about the current state of COVID in America's nursing homes. For those living and working in skilled nursing facilities, this pandemic is far from over, isn't that right? [00:31:01] Megan O’Reilly: Sadly, that's correct, Bill. The AARP Nursing Homes COVID Dashboard shows that transmission in nursing homes remains significantly elevated compared to the rest of the population. One of the most important things people can do is make sure their loved ones are vaccinated and have received the recommended boosters. Nearly half of residents and more than half of staff are not up-to-date with their shots, and this could have deadly consequences as we head into cold and flu season. This is the time to be an advocate for your loved one. Contact your nursing home and ask about vaccination rates and plans to keep residents safe this fall and winter. And if you need help knowing what to ask, go to AARP.org/nursinghomes and see our article, "10 COVID-19 Questions to Ask a Nursing Home." [00:31:53] OK, that was AARP.org/nursinghomes. That's a terrific story. The 10 questions to ask a nursing home. It's really helpful, and we're updating it regularly. So take a look at that on AARP.org. Thanks so much for being here today, Megan. If our listeners want to get involved with AARP’s advocacy, how can they do it? [00:32:20] Megan O’Reilly: Sure, we encourage everyone to go online to AARP.org/getinvolved. That's AARP.org/getinvolved, and sign up to be an e-activist. You'll receive email action alerts with easy ways to make your voice heard, whether on COVID, protecting your hard-earned Social Security and Medicare benefits, and more. Once again, that's AARP.org/getinvolved. It's an easy way to make a big difference. [00:32:54] All right. Thank you so much, Megan, for that update. Really appreciate your being here today. Let us turn back to our experts. … Dr. Gounder, you recently wrote an article in The Atlantic that said Americans and political leaders lack the moral imagination to solve the COVID crisis, that we needlessly tolerate 150,000 deaths per year, and too often ignore elderly people, people of color, and people with disabilities. Can you share more about your concerns? [00:33:34] Céline Gounder: Sure. We're still seeing between 300 and 500 deaths from COVID per day, which translates to 150,000 additional deaths per year in the United States from COVID. And at the same time, we've also seen deaths from COVID shift older. Ninety percent of deaths from COVID are now occurring among people 65 and older, and 40 percent of COVID deaths are now occurring among people 85 and older. So the demographics have really shifted older since the summer of 2021, when it was about 50/50 deaths among people over and under 65. We also know that people of color and people who are immunocompromised or have disabilities are at higher risk for comp … [dogs barking] Sorry, the dogs ... are higher risk for complications from COVID, and unfortunately the vast majority of the American population thinks the pandemic is over and has stopped taking precautions. To prevent transmission, I think we're thinking too narrowly about what we can do to reduce the risk. So yes, masks and vaccines. Vaccines are important, but there are other highly effective tools, too. For example, improving indoor air quality with ventilation and air filtration. For the holidays you can get yourself some portable HEPA air filtration units for your home, put them in places where the family or friends congregate — kitchen, living room, dining room, for example. We should also make a lot more use of COVID testing and treatment, and again, a reminder that if you do test positive for COVID, you can be treated with Paxlovid, which is highly effective in keeping people out of the hospital. And finally, when the public health emergency does come to an end, some people may be losing their Medicaid coverage. Medicaid covers low-income people. Medicare will stay the same, but some people might lose that Medicaid coverage, which can really create hardship for folks who are already struggling to get by. [00:35:39] Thanks for that, Dr. Gounder, but let's talk a little bit more about some of the tools you mentioned there. We've talked a little bit about the newest vaccines. I wonder how effective they are against the subvariants that you and Dr. Tan have talked about; and also at-home COVID tests. Are they effective in detecting these subvariants? [00:35:59] Céline Gounder: The at-home COVID tests still work perfectly well with the new subvariants. Same goes for Paxlovid, the pill that you can take for COVID. Both of those tools still work very well, just as well for the new subvariants. The vaccines may not work as well, and the monoclonal antibodies may not work as well. Where we need to sort of adjust our expectations of vaccines is that the vaccines will keep you out of the hospital. They will prevent you from dying. They may not prevent all infections, and so it's very important that you get vaccinated, but you may still want to be layering other tools like masking, like those HEPA air filtration units, like testing and treatment to further reduce your risk. [00:36:48] I like that notion of layering on protection. Makes a lot of sense. Dr. Gounder, great effort is being made to understand what causes and alleviates so-called long COVID. This week, in fact, researchers at the US Department of Veterans Affairs said that the antiviral Paxlovid, which you just mentioned, reduces the chances of certain long-COVID conditions by a quarter. Why do some people continue to experience COVID complications and how dangerous are they? [00:37:17] Céline Gounder: Well, one thing we have seen is that if you have immunity, if you've been vaccinated, your risk of developing long COVID is lower than if you have not been vaccinated. We don't entirely understand what causes long COVID yet. It's probably a cluster of a number of different syndromes, each of which have a slightly different set of symptoms caused slightly differently, but we know that, again, vaccination will reduce your risk and getting treated with Paxlovid if you are infected does seem to be, at least from the early data, does seem to be protective. It's yet another reason, if you have symptoms to get yourself tested for COVID, so you can get treated and so you're less likely to end up with long COVID. [00:38:04] OK, very good. Dr. Tan, let me bring you back in. We're beginning to see school closures around the country in response to the flu and the RSV infections. What do grandparents helping care for school-aged grandchildren or great-grandchildren need to know about RSV and flu outbreaks? [00:38:24] L.J. Tan: Yeah, thanks Bill. I think to follow up on some of this conversation from earlier, I think if you're taking care of a child that's younger than school age, the first thing, get the flu vaccine because we can take flu off the table. Again, to echo Dr. Gounder's point, it reduces your risk of hospitalization, reduces your risk of death, reduces your risk of severe disease. It may not entirely protect you from getting infected, but it does have strong benefits — and so get vaccinated against flu. Take that off the table. Now, as we've already talked about RSV, we don't have a vaccine for that yet. And, unfortunately, we do want to keep away from getting infected with RSV because of some of the reasons Dr. Gounder had already mentioned, including this idea that it exacerbates or makes worse some of the chronic conditions that older people tend to have — things like, for example, a heart disease; COPD, which is a chronic obstructive pulmonary disease, lung disease, in other words. Diabetes, for example, is another one that we know flu exacerbates as well or makes worse. So we would urge that in the process of taking care of a school-aged child who might have been exposed to an outbreak, that you keep that in mind and take the precautions of layering on infection control things like masking, frequent sanitizing, washing of hands, making sure that the child covers their cough so that if possible at all, you avoid being infected. And, of course, you know, what I would say is if you can avoid getting in contact with someone who's actually symptomatic, that is something you want to do. [00:39:55] Bill Walsh: Thanks very much for that, Dr. Tan. Now my colleague, Megan O'Reilly, was talking about some concerns in our nation's nursing homes, particularly the low vaccination rates there. To give us more insights on long-term care facilities, I'd like to bring in Sam Brooks to our conversation. Sam is the director of public policy at the National Consumer Voice for Quality Long-Term Care, a national consumer advocacy group. Sam, welcome to the program. I'd like to ask you … you know nearly one half of long-term care facility residents are not up-to-date with COVID vaccines. What are facilities doing to ensure that residents have access to the newest COVID and flu vaccines, and how are they educating residents? [00:40:44] Sam Brooks: Thanks for that question. First, just let me say what a wonderful call this has been and how informative it has been. The statistic that you mentioned is very concerning to us. And it's, unfortunately, not clear just what facilities are doing to ensure that both staff and residents are up- to-date with their boosters. We saw at the beginning when vaccines first became available, there was an all-out effort, really from the government down; there were vaccine clinics, there were partnerships formed with various pharmacies, and you saw a real high uptake of vaccinations in residents. You know, 8 or 9 out of 10 residents had their first primary set of vaccinations. But now you've just seen, not a corresponding effort from the government, when it comes to boosters, and it's very concerning to us. We're hearing from residents — or we're hearing from residents and long-term care ombudsmen, that residents don't understand why they continue to need to get shots. And we really believe, unfortunately, I mean we would hope that most residents could be on a call like this today to see just how important this is. And I know that you know there's 15,000 nursing homes across the United States. Unless we have a concerted effort, really, from the federal government and state governments to say, we need to do some education around this, we're going to see these dismal numbers continue. And going into the fall flu and COVID season, it's very concerning for us. [00:42:24] Bill Walsh: Thanks for that, Sam. Now according to October CDC data, long-term care facilities staff and home health care workers have the lowest COVID vaccination rates, lowest COVID booster rates, and lowest flu vaccination rates among health care professionals. Why is this, and where do you turn if you have concerns or need help working with a long-term care facility? [00:42:52] Sam Brooks: Again, I was looking at the data. Three out of four nursing home direct care staff aren't up-to-date on their vaccines. The federal government, the Centers for Medicare and Medicaid Services, instituted a mandate that staff be vaccinated. And you saw that … about 9 out of 10 staff got their first primary set of vaccinations. But that's just not true with boosters. And we're concerned, again, that there isn't a concerted effort by the government to say, hey, we're going to update our guidance and require staff to be updated with boosters. And I think this makes both residents and families and their loved ones need to be more hypervigilant when making decisions about nursing homes. Nursing homes, if you go to Care Compare … on medicare.gov, you can see the vaccination rates and the booster rates for each nursing home. But those are the types of questions that you need to be asking facilities when you're thinking about the safety of yourself or a loved one. What are the vaccination rates for staff? What are the plans to get your vaccination rates up for staff and residents? Because there's just a lot of things going on right now that are putting residents at risk. [00:44:11] Bill Walsh: Yeah, it sounds like it's really time to be an advocate for your loved ones in those facilities. Thanks so much for that, Sam. We're going to come back with more questions for you shortly. And now it's time to address more of our listener questions. … Jesse, who do we have on the line next? [00:44:37] Jesse Salinas: OK, Bill. We have a lot of questions on YouTube, on Facebook, and even in our queue from people who are asking about their confusion with how many shots they should have taken or need to take or have to take before they can get the new booster. So can your experts maybe talk about that? [00:44:52] Bill Walsh: Dr. Gounder, can you walk us through that? [00:44:54] Céline Gounder: As long as you've had two shots, don't worry about counting shots anymore. Just make sure you get the most up-to-date booster available as they come out. So as long as you've had two shots, at a minimum, you can go out and get the updated bivalent omicron boosters, those new ones that have just come out. [00:45:16] Very good. Keep it simple. All right, Jesse, who do we have up next? [00:45:21] Jesse Salinas: This is from Lana in New York. [00:45:23] Bill Walsh: Hey, Lana. welcome to our program. Go ahead with your question. [00:45:28] Lana: Hi. I was wondering if it is safe to get the flu vaccine if you have an allergy to eggs, and also if the eggs are contained in the flu vaccine. [00:45:40] Bill Walsh: Dr. Tan, do you want to field that one? [00:45:42] L.J. Tan: Yes, actually there's been a lot of research on this recently and it is absolutely safe to take the flu vaccine now, even if you have an allergy to eggs. That being said, the CDC does advise that if … you’re known to have a severe allergy to eggs, you should try to get the vaccine in a place where someone can watch you after you get the flu vaccine so that, you know, just in case. There is a vaccine out there … there are several vaccines out there that do not have eggs that you can consider. One is called Flucelvax, and the other one's called Flublok. And Flublok indeed is that same vaccine that's recommended for 65 and older. They do not have egg components that are of concern. [00:46:21] Bill Walsh: Hmm. That's interesting. I know for the COVID vaccine, people are urged to wait 15 minutes or so to see if there's an allergic reaction. Is it the same guidance for the flu vaccine? [00:46:31] L.J. Tan: Yes, it is. And also to do it in a location where there is obviously access to epinephrine in case there is what we call an anaphylaxis reaction. [00:46:44] Bill Walsh: Very good. Thank you so much. Jesse, who do we have up next? [00:46:48] Jesse Salinas: Our next question is going to be from Bob in North Dakota. [00:46:52] Bill Walsh: Hey Bob, welcome to the program. Go ahead with your question. [00:46:56] Bob: Thank you. My question has to do with the flu vaccine. I did receive my flu vaccine earlier in October; however, I was not 65 and so I didn't get the high dose. My wife is immunocompromised, and now I am 65, so I'm wondering if and when I could get the high-dose vaccine later on. [00:47:22] Bill Walsh: OK, Dr. Tan, do you have any advice for Bob? [00:47:26] L.J. Tan: I can give you the official advice, and then I'm going to give you my personal opinion. And I will caveat that. So officially, you've got your flu vaccine, sir. You don't need another flu vaccine. My personal position on this also is that if you turn 65, you just have to realize that if you get a second flu vaccine, it will not be covered by insurance. It will not be covered by Medicare because you are only allowed one flu vaccine in one season. That being said, there is no safety issue with getting two flu vaccines in the same season if they're separated by more than four weeks. And that's just me speaking as an expert. It is not an endorsed position by anybody. [00:48:09] Bill Walsh: Now, you said earlier, Dr. Tan, it seemed that the flu vaccine was pretty effective this season. Does that weigh into this at all since Bob has already gotten that flu vaccine? [00:48:24] L.J. Tan: It is the same flu vaccine in terms of the strains that are covered in the vaccine, so that's not the equation here. I think the good news, as I said — when I said earlier, it's about 92 to 100 percent matching, the vaccine is 92 to 100 percent matching what's circulating. So that's a very good thing. However, as Dr. Gounder has already pointed out, we don't have real data on that. I mean, until the season continues to progress and we see how well the vaccine actually works in people, we don't have actual data in terms of how well it's preventing hospitalizations, preventing disease, preventing deaths. [00:49:04] Bill Walsh: Got it. OK. Thanks very much for that. Jesse, who do we have up next? [00:49:08] Jesse Salinas: The next caller is going to be Dolores in Nevada. [00:49:11] Bill Walsh: Hey Dolores, welcome to our program. Go ahead with your question. [00:49:15] Dolores: Hi, my question is, excuse me ... [00:49:18] Bill Walsh: Are you still with us, Dolores? [00:49:25] Dolores: Yes. I waited so long; I can't remember what it was. [chuckles] [00:49:35] Jesse Salinas: All right, let's move on, Bill. [00:49:37] Bill Walsh: All right. Sorry about that, Dolores. [00:49:40] Jesse Salinas: Frances from Oklahoma. [00:49:42] Bill Walsh: Hey Frances. Welcome to our program. Go ahead with your question. [00:49:45] Frances: Yes. I was just asking about the Tylenol and [inaudible], and I think I got my question answered on that. But anyway, I've got a husband in a nursing home, and they are really good about … I've got power of attorney over him, so they send me letters each year for me to sign for him to get his shots. And I always sign them so they don't have to worry about whether they can give it or not. [00:50:21] Bill Walsh: Hmm. Any concern whether you should be signing those or whether those are adequate to make sure that he's getting the shots? [00:50:30] Jesse Salinas: I think that's right, Bill. I think we've lost her. [00:50:32] Bill Walsh: OK. Sam, do you want to take that? [00:50:35] Sam Brooks: Sure, I mean when it comes to getting your vaccinations annually, primarily the facility must … first of all, the facility must make these available to residents. And residents themselves should be able to make those choices. But in instances where residents may not be able to, for instance, because of a cognitive impairment or an inability to communicate for some reason, they need to be talking with guardians or loved ones just to make them aware of what is available. And if you are making those decisions for a loved one that's in a nursing home, you can be proactive. You can call them and ask them, first, when are you offering boosters? What boosters are you offering? And also, what type of treatments are you offering for COVID should my loved one get it? So oftentimes you do have to be a little extra active as we talked about before. I'm glad to hear that this particular facility is sending letters. I imagine that might be true for some, but it's always good; it's never good to assume that that will happen, especially if you're the one making those decisions. But, of course, we always want those decisions to be made by residents themselves when they can — but it's always good to have as many people advocating for that safety as possible for folks in nursing homes. [00:52:04] Bill Walsh: OK, thanks so much for that, Sam. And Dolores, who had called us earlier, I believe she was going to ask about the cost of boosters. Dr. Gounder, are the boosters still free and will they always be free? [00:52:17] Céline Gounder: The boosters are still free for now. So the federal government has purchased the boosters for this fall and winter season. However, in the future, unless Congress decides to allocate more money, and that's really a decision for Congress to make — Congress allocates funding, and it has the power of the purse string, not the president. So if Congress decides to allocate more funding to purchase more vaccines, we may have free vaccines in the future, but that does not seem to be in the cards right now. [00:52:51] OK, thanks very much for that. Sam, you were just talking about nursing homes. Let's dig into that a little bit. Last month, the Centers for Medicare and Medicaid Services relaxed nursing home vaccine requirements as long as good faith efforts are being made to achieve compliance. What does this mean for people with families in long-term care facilities? [00:53:16] Sam Brooks: Yeah, I'm glad you brought that up. We were very, for lack of a better term, disturbed when we heard about this. If you look at the numbers now, they're dismal. And despite this fact in its announcement that it was going to be relaxing enforcement penalties of the vaccine mandate, they called it a success. And when 3 out of 4 staff aren't up-to-date with their boosters and where only 41 percent of residents are, we don't see that as a success. And we do not see this. It's a sign, as Dr. Tan I think indicated, that it's … sending a false sense of security to residents when we're going into a season here that we really need to protect residents. So we're concerned about that. And we should, for families and residents, they need to be talking to their facilities. I mean, a good faith effort isn't enough. We need to see those numbers raised. And if you're in a facility or your loved one is in a facility that has low vaccination rates, you can call that administrator or call that facility and say, what are your plans to get your staff up? And they need to be providing you with that information. And just another thing around this is at the same time, CDC has relaxed masking guidance in health care settings. And we find this particularly troublesome in nursing homes, saying masking only needs to be done or should be done where community transmission levels are high. And we just think it's particularly, and I'm just speaking for nursing homes here, that this is just a very long, a step in the wrong direction. When again, 3 out of 4 staff are not up-to-date with their vaccines, you need to be hypervigilant about whether that facility is requiring health care staff to wear masks. And we're hearing from a lot of residents that they're not. So there's a couple things here going on that we're really concerned about that are coming out just at the wrong time. And really, as you say, you gotta be on your toes to protect your loved ones. [00:55:36] Bill Walsh: Let's, let me dig into that just a little bit. I mean, what kind of rights do families have to advocate on behalf of their loved ones in nursing homes? I know just from past programs people feel it's often opaque. They don't really know what's going on inside the facilities. It kind of depends on facility to facility and management company to management company, but what rights do they have, and do they have any allies on the outside they can turn to for assistance? [00:56:03] Sam Brooks: Sure, that's a great question and I think you're absolutely right. Unfortunately, the way the system operates, it can be two facilities — one across the street from each other — operating at very different levels. I think the most important resources oftentimes to residents and families are the Long-Term Care Ombudsman. The Long-Term Care Ombudsman is an office of advocates for residents, and each nursing home has a designated long-term care ombudsman — that number must be provided and displayed visually someplace in the facility. And you can call and express your concern with the ombudsman, and the ombudsman will go out and speak to the resident and also act as an advocate on behalf of the resident. And, in addition to that, they can also talk about what rights residents have because there's lots of rights that residents are afforded, but they often don't hear about from the facility. And the second option is filing a complaint with a state survey agency or a state regulatory agency. And this information also needs to be readily available to residents. If you have a concern that your loved one is not getting access to vaccines or that a facility is not observing or practicing proper infection-control procedures, you need to file those complaints and get people out there to take a look and make sure that residents are protected. So there are resources. You can also go on the website, go to Consumer Voice, theconsumervoice.org, and we have pages and pages of ways to advocate on behalf of residents in nursing homes. [00:57:43] Bill Walsh: OK. Theconsumervoice.org. And that long-term care ombudsman program is free, is that correct? [00:57:51] Sam Brooks: Oh, of course. Yep, it's free. The numbers, you can access those numbers; if you Google your state and long-term care ombudsman, it should come up. You can also get the information at our website. We have … you can click on the map, and we'll give you all kinds of helpful numbers, and that is a free, confidential service that has nothing to do with the facility. It's not hired by the facilities; they're advocates for you and primarily for residents, and I encourage folks to take advantage of them. [00:58:24] Bill Walsh: Just very quickly, how are nursing homes held accountable if they fail to provide adequate care? [00:58:30] Sam Brooks: Well, I mean, primarily, the primary mechanism, in theory at least, is that states are supposed to go out and enforce the federal regulations. Unfortunately, we're seeing difficulties with that now, attributable to the pandemic. But facilities can face a variety of penalties — including financial penalties and also being excluded from the Medicare and Medicaid programs. And that's really what most facilities want to avoid. However, we — and I think Megan would agree with me — we need to have stronger enforcement from the federal government around these regulations to ensure that the penalties that are in place, facilities do pay to make sure that residents are safe. [00:59:24] Bill Walsh: Sam Brooks, thank you so much, and thanks so much also to Drs. Céline Gounder and L.J. Tan. This has been a really informative discussion. We really appreciate all of our guests for being here and offering their insights today. And thank you, our AARP members, volunteers and listeners for participating in this discussion. AARP, a nonprofit, nonpartisan membership organization has been working to promote the health and well-being of older Americans for more than 60 years. In the face of this crisis, we're providing information and resources to help older adults and those caring for them protect themselves from the virus, prevent its spread to others while taking care of themselves. All of the resources referenced today, including a recording of the Q&A event can be found at AARP.org/coronavirus starting Nov. 11. Go there if your question was not addressed, and you'll find the latest updates as well as information created specifically for older adults and family caregivers. We hope you learned something that can help keep you and your loved ones healthy. Please join us again Dec. 15 for another Tele-Town Hall on COVID-19. Thank you very much and have a great day. This concludes our call.
COVID Boosters Flu Season and the Impact on Nursing Homes
Thursday, November 10, 1 p.m. (ET) Call toll-free 855-274-9507 to join the event and ask a question Join AARP for a Coronavirus tele-town hall where we will address the topic of Boosters, Flu Season and the Impact on Nursing Homes. As we prepare to gather with friends and family this holiday season, it is critical to take the necessary precautions to protect ourselves and our loved ones against influenza viruses and COVID-19. Experts are particularly concerned that flu season could be worse than normal this year making it even more important to get vaccinated. We will also address ways to keep your loved ones in nursing homes safe and protected this winter. This event will focus on the following areas: Importance of staying up-to-date on your COVID booster and flu shot as we enter a particularly challenging cold and flu season. The latest updates on COVID boosters, variants, flu shots and how to stay safe as we prepare to gather with family and friends. What you can do to ensure the safety and protection of your loved one residing in a nursing home. Speakers: Celine Gounder, M.D., Senior Fellow & Editor-at-Large for Public Health at the Kaiser Family FoundationL.J. Tan, M.D., Chief Strategy Officer, Immunization Action Coalition Sam Brooks, Director of Public Policy, The National Consumer Voice for Quality Long-Term Care For the latest coronavirus news and advice, .
Replay previous AARP Coronavirus Tele-Town Halls
- Coronavirus: Vaccines, Treatments and Flu Season - Coronavirus: Vaccines, Flu Season and Telling Our Stories - Coronavirus: Finding Purpose as we Move Beyond COVID - Coronavirus: Living With COVID - Coronavirus: Life Beyond the Pandemic - Coronavirus: Boosters, Testing and Nursing Home Safety - Coronavirus: Impact on Older Adults and Looking Ahead - Coronavirus: What We’ve Learned and Moving Forward - Coronavirus: Current State, What to Expect, and Heart Health - Coronavirus: Omicron, Vaccines and Mental Wellness - Coronavirus: Omicron, Looking Ahead, and the Impact on Nursing Homes - Coronavirus: Staying Safe During Changing Times
- Coronavirus: What You Need to Know About Boosters, Vaccines & Variants - Coronavirus: Boosters, Vaccines and Your Health - Coronavirus: Your Questions Answered — Vaccines, Misinformation & Mental Wellness - Coronavirus: Boosters, Health & Wellness - Coronavirus: Protecting Your Health & Caring for Loved Ones - Coronavirus: Boosters, Flu Vaccines and Wellness Visits - Coronavirus: Delta Variant, Boosters & Self Care - Coronavirus: Staying Safe, Caring for Loved Ones & New Work Realities - Coronavirus: Staying Safe, New Work Realities & Managing Finances - Coronavirus: Staying Safe in Changing Times - The State of LGBTQ Equality in the COVID Era - Coronavirus: Vaccines And Staying Safe During “Reopening” - Coronavirus: Your Health, Finances & Housing - Coronavirus: Vaccines, Variants and Coping - Coronavirus: Vaccines, Variants and Coping - Your Vaccine Questions Answered and Coronavirus: Vaccines and Asian American and Pacific Islanders - Coronavirus and Latinos: Safety, Protection and Prevention and Vaccines and Caring for Grandkids and Loved Ones
- Coronavirus and The Black Community: Your Vaccine Questions Answered - Coronavirus: The Stimulus, Taxes and Vaccine - One Year of the Pandemic and Managing Personal Finances and Taxes - Coronavirus Vaccines and You - Coronavirus Vaccines: Your Questions Answered - Coronavirus: Vaccine Distribution and Protecting Yourself
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