1 00:00:05,600 --> 00:00:08,960 THANK YOU FOR JOINING US FOR OUR 2 00:00:08,960 --> 00:00:12,440 FEDERAL PARTNERS' WEBINAR SERIES 3 00:00:12,440 --> 00:00:14,160 IN THE FOCUS ON AGING SERIES. 4 00:00:14,160 --> 00:00:19,000 TODAY'S TOPIC IS COVID-19. 5 00:00:19,000 --> 00:00:20,960 WE ON BEHALF OF OUR FEDERAL 6 00:00:20,960 --> 00:00:22,680 PARTNERS, I WANT TO WELCOME YOU, 7 00:00:22,680 --> 00:00:25,640 AND OUR FEDERAL PARTNERS' LOGOS 8 00:00:25,640 --> 00:00:26,280 ARE LISTED BELOW. 9 00:00:26,280 --> 00:00:29,240 THEY ARE THE ADMINISTRATION FOR 10 00:00:29,240 --> 00:00:31,600 COMMUNITY LIVING, THE HEALTH AND 11 00:00:31,600 --> 00:00:32,760 HUMAN SERVICES OFFICE OF THE 12 00:00:32,760 --> 00:00:34,920 ASSISTANT SECRETARY FOR PLANNING 13 00:00:34,920 --> 00:00:38,120 AND EVALUATION, THE CDC, CMS, 14 00:00:38,120 --> 00:00:40,120 WHICH IS CENTERS FOR MEDICARE 15 00:00:40,120 --> 00:00:42,320 AND MEDICAID SERVICES, HRSA, 16 00:00:42,320 --> 00:00:44,360 WHICH IS HEALTH RESOURCES AND 17 00:00:44,360 --> 00:00:46,640 SERVICES ADMINISTRATION, THE 18 00:00:46,640 --> 00:00:50,160 IHS, THE INDIAN HEALTH SERVICE, 19 00:00:50,160 --> 00:00:51,800 US AT THE NATIONAL INSTITUTE ON 20 00:00:51,800 --> 00:00:54,600 AGING, WHICH IS PART OF THE 21 00:00:54,600 --> 00:00:55,640 NATIONAL INSTITUTES OF HEALTH, 22 00:00:55,640 --> 00:00:57,600 AND THE U.S. DEPARTMENT OF 23 00:00:57,600 --> 00:01:05,480 VETERANS AFFAIRS. 24 00:01:05,480 --> 00:01:07,760 SO THE WEBINAR OVERVIEW, TODAY'S 25 00:01:07,760 --> 00:01:09,280 WEBINAR WILL FEATURE 26 00:01:09,280 --> 00:01:10,080 PRESENTATIONS ON THE FOLLOWING. 27 00:01:10,080 --> 00:01:11,520 ONE IS GOING TO BE AN OVERVIEW 28 00:01:11,520 --> 00:01:14,200 OF COVID-19 AND AGING GENERALLY. 29 00:01:14,200 --> 00:01:16,520 THE NEXT WILL BE IMPACT OF THE 30 00:01:16,520 --> 00:01:18,160 COVID-19 PANDEMIC ON THE 31 00:01:18,160 --> 00:01:21,360 WELL-BEING OF OLDER ADULTS FROM 32 00:01:21,360 --> 00:01:22,320 UNDERSERVED COMMUNITIES, THEN 33 00:01:22,320 --> 00:01:24,960 WE'LL HEAR ABOUT LONGITUDINAL 34 00:01:24,960 --> 00:01:26,400 TRAJECTORIES OF COGNITIVE AND 35 00:01:26,400 --> 00:01:29,000 FUNCTIONAL RECOVERY AFTER SEVERE 36 00:01:29,000 --> 00:01:31,240 COVID-19. 37 00:01:31,240 --> 00:01:33,800 NEXT WE'LL HEAR COVID-19 AND 38 00:01:33,800 --> 00:01:36,760 DEMENTIA, TRANSLATING FINDINGS 39 00:01:36,760 --> 00:01:38,120 FROM THE INITIAL NEW YORK CITY 40 00:01:38,120 --> 00:01:39,520 WAVE INTO LONGITUDINAL STUDIES 41 00:01:39,520 --> 00:01:40,920 OF COGNITIVE AGING. 42 00:01:40,920 --> 00:01:43,880 AND FINALLY, COVID-19 AND LONG 43 00:01:43,880 --> 00:01:45,280 COVID IN LONG-TERM CARE 44 00:01:45,280 --> 00:01:52,080 SETTINGS. 45 00:01:52,080 --> 00:01:52,840 OUR ILLUSTRIOUS SPEAKERS TODAY, 46 00:01:52,840 --> 00:01:54,360 WE HAVE FIVE OF THEM. 47 00:01:54,360 --> 00:01:55,480 DR. PETER BRISS FROM THE 48 00:01:55,480 --> 00:01:56,440 NATIONAL CENTER FOR CHRONIC 49 00:01:56,440 --> 00:01:58,600 DISEASE PREVENTION AND HEALTH 50 00:01:58,600 --> 00:02:01,480 PROMOTION AT THE CDC. 51 00:02:01,480 --> 00:02:03,880 DR. MARIA MARQUINE, FROM DUKE 52 00:02:03,880 --> 00:02:05,360 UNIVERSITY, DEPARTMENT OF 53 00:02:05,360 --> 00:02:06,600 MEDICINE, DIVISION OF 54 00:02:06,600 --> 00:02:07,920 GERIATRICS, DUKE CENTER FOR THE 55 00:02:07,920 --> 00:02:11,520 STUDY OF AGING AND HUMAN DEVELOP 56 00:02:11,520 --> 00:02:12,280 DEVELOPMENT. 57 00:02:12,280 --> 00:02:16,640 NEXT, DR. JENNIFER FRONTERA FROM 58 00:02:16,640 --> 00:02:19,320 THE NEW YORK UNIVERSITY LANGEONE 59 00:02:19,320 --> 00:02:21,720 HEALTH. 60 00:02:21,720 --> 00:02:22,760 THEN DR. JAMES NOBLE, IRVINGTON 61 00:02:22,760 --> 00:02:26,800 MEDICAL CENTER, AND FINALLY, DRR 62 00:02:26,800 --> 00:02:28,280 EMERITUS FROM ST. LOUIS 63 00:02:28,280 --> 00:02:29,600 UNIVERSITY. 64 00:02:29,600 --> 00:02:31,520 WE'RE GOING TO HAVE A QUESTION 65 00:02:31,520 --> 00:02:33,840 AND ANSWER SESSION PERIOD AT THE 66 00:02:33,840 --> 00:02:34,200 END. 67 00:02:34,200 --> 00:02:36,040 AS YOU CAN HEARING SPEAKERS, YOU 68 00:02:36,040 --> 00:02:39,760 ARE INVITED TO PROVIDE US WITH 69 00:02:39,760 --> 00:02:41,640 YOUR QUESTIONS, AND THE WAY YOU 70 00:02:41,640 --> 00:02:43,880 DO THAT IS CLICK ON THE LIVE 71 00:02:43,880 --> 00:02:45,440 FEEDBACK BUTTON AT THE BOTTOM OF 72 00:02:45,440 --> 00:02:47,400 THE VIDEOCAST PAGE TO SUBMIT 73 00:02:47,400 --> 00:02:53,760 THAT QUESTION. 74 00:02:53,760 --> 00:02:57,160 WE WILL BEGIN WITH DR. BRISS. 75 00:02:57,160 --> 00:02:59,880 >> GOOD MORNING, EVERYONE. 76 00:02:59,880 --> 00:03:01,600 I'M DELIGHTED TO BE HERE THIS 77 00:03:01,600 --> 00:03:05,120 MORNING, AND I'LL OPEN WITH AN 78 00:03:05,120 --> 00:03:11,120 OVERVIEW OF COVID AND AGING. 79 00:03:11,120 --> 00:03:12,560 SO THE STRUCTURE OF MY 80 00:03:12,560 --> 00:03:14,320 DISCUSSION TODAY WILL ADDRESS 81 00:03:14,320 --> 00:03:15,720 SEVERAL INTERRELATED ISSUES, SO 82 00:03:15,720 --> 00:03:20,120 AGING ITSELF, ASSOCIATIONS OF 83 00:03:20,120 --> 00:03:22,840 AGING AND CHRONIC CONDITIONS AND 84 00:03:22,840 --> 00:03:24,800 DISABILITY, AND THE IMPACTS OF 85 00:03:24,800 --> 00:03:26,000 ADVERSE SOCIAL DETERMINANTS OF 86 00:03:26,000 --> 00:03:29,120 HEALTH. 87 00:03:29,120 --> 00:03:31,720 AFTER I TEE UP SOME ISSUES ABOUT 88 00:03:31,720 --> 00:03:33,160 HOW ALL THOSE THINGS RELATE TO 89 00:03:33,160 --> 00:03:34,360 COVID-19, WE'LL TALK A LITTLE 90 00:03:34,360 --> 00:03:35,840 ABOUT HOW TO PROTECT YOURSELF 91 00:03:35,840 --> 00:03:43,960 AND OTHERS. 92 00:03:43,960 --> 00:03:45,800 SO OLDER ADULTS ARE AT INCREASED 93 00:03:45,800 --> 00:03:47,560 RISK OF SERIOUS OUTCOMES OF 94 00:03:47,560 --> 00:03:49,680 COVID-19. 95 00:03:49,680 --> 00:03:51,920 NEARLY THREE QUARTERS OF ALL 96 00:03:51,920 --> 00:03:52,680 COVID-19-RELATED DEATHS IN THE 97 00:03:52,680 --> 00:03:54,520 UNITED STATES HAVE OCCURRED IN 98 00:03:54,520 --> 00:03:57,840 PEOPLE WHO ARE AGED 65 YEARS AND 99 00:03:57,840 --> 00:03:58,240 OLDER. 100 00:03:58,240 --> 00:04:00,280 IN THE U.S. AND ELSEWHERE, OLDER 101 00:04:00,280 --> 00:04:01,560 ADULTS WERE A PRIORITY 102 00:04:01,560 --> 00:04:03,200 POPULATION FOR COVID-19 103 00:04:03,200 --> 00:04:04,960 VACCINATION, BUT ONLY ABOUT 40% 104 00:04:04,960 --> 00:04:07,680 OF PEOPLE AGED 65 AND OLDER HAVE 105 00:04:07,680 --> 00:04:10,520 HAD A SECOND BOOSTER, AND 106 00:04:10,520 --> 00:04:12,920 SMALLER NUMBERS HAVE HAD THE 107 00:04:12,920 --> 00:04:16,440 BRAND NEW BOOSTERS. 108 00:04:16,440 --> 00:04:17,320 WHICH WERE RECOMMENDED IN THE 109 00:04:17,320 --> 00:04:20,480 LAST COUPLE OF WEEKS. 110 00:04:20,480 --> 00:04:21,280 MORTALITY RATES HAVE BEEN HIGHER 111 00:04:21,280 --> 00:04:23,480 IN PLACES LIKE HONG KONG, WHERE 112 00:04:23,480 --> 00:04:25,280 OLDER ADULTS WERE NOT 113 00:04:25,280 --> 00:04:26,400 PRIORITIZED FOR VACCINATION, AND 114 00:04:26,400 --> 00:04:28,240 THE RISK OF DEATH AMONG OLDER 115 00:04:28,240 --> 00:04:30,640 ADULTS WHO WERE NOT VACCINATED 116 00:04:30,640 --> 00:04:34,040 CAN BE 20 TIMES THE RISK IN 117 00:04:34,040 --> 00:04:38,640 PEOPLE WHO WERE VACCINATED. 118 00:04:38,640 --> 00:04:40,800 JUST A PROCESS POINT, I'M GOING 119 00:04:40,800 --> 00:04:44,000 TO TEE UP A LOT OF ISSUES, AND 120 00:04:44,000 --> 00:04:45,760 IF PEOPLE WOULD LIKE TO TAKE 121 00:04:45,760 --> 00:04:47,120 DEEPER DIVES INTO ANY OF THOSE, 122 00:04:47,120 --> 00:04:48,240 I'VE INCLUDED FOOTNOTES THAT 123 00:04:48,240 --> 00:04:54,600 TAKE YOU TO MORE INFORMATION. 124 00:04:54,600 --> 00:04:59,080 AGING IS ASSOCIATED WITH CHRONIC 125 00:04:59,080 --> 00:05:01,520 CONDITIONS. 126 00:05:01,520 --> 00:05:03,160 60% OF AMERICAN ADULTS HAVE AT 127 00:05:03,160 --> 00:05:04,800 LEAST ONE CHRONIC CONDITION, AND 128 00:05:04,800 --> 00:05:07,160 ABOUT 2 IN 5 HAVE MORE THAN ONE. 129 00:05:07,160 --> 00:05:10,760 AMONG PEOPLE WHO ARE 65 AND 130 00:05:10,760 --> 00:05:12,680 OLDER, 4 PEOPLE OUT OF 5 HAVE 131 00:05:12,680 --> 00:05:19,000 MORE THAN ONE CHRONIC CONDITION. 132 00:05:19,000 --> 00:05:21,080 DURING THE COVID-19 PANDEMIC, 133 00:05:21,080 --> 00:05:22,800 MANY CHRONIC CONDITIONS SUCH AS 134 00:05:22,800 --> 00:05:24,480 HEART DISEASE, CANCER, CHRONIC 135 00:05:24,480 --> 00:05:27,440 LUNG DISEASES AND OTHERS WERE 136 00:05:27,440 --> 00:05:29,440 ASSOCIATED WITH INCREASED 137 00:05:29,440 --> 00:05:30,160 COVID-19-RELATED MORBIDITY AND 138 00:05:30,160 --> 00:05:31,880 MORTALITY. 139 00:05:31,880 --> 00:05:33,120 MULTIPLE CHRONIC CONDITIONS WERE 140 00:05:33,120 --> 00:05:35,520 ASSOCIATED WITH HIGHER RATES OF 141 00:05:35,520 --> 00:05:40,760 POOR OUTCOMES. 142 00:05:40,760 --> 00:05:42,200 THE EFFECTS OF THE PANDEMIC ON 143 00:05:42,200 --> 00:05:42,960 PEOPLE WITH CHRONIC CONDITIONS 144 00:05:42,960 --> 00:05:44,920 WERE NOT LIMITED TO THE DIRECT 145 00:05:44,920 --> 00:05:46,680 EFFECTS OF COVID-19. 146 00:05:46,680 --> 00:05:48,680 DURING THE PANDEMIC, THE USE OF 147 00:05:48,680 --> 00:05:50,960 HEALTHCARE SERVICES DECLINED. 148 00:05:50,960 --> 00:05:52,600 FOR PREVENTIVE, ROUTINE AND EVEN 149 00:05:52,600 --> 00:05:54,760 EMERGENCY CARE. 150 00:05:54,760 --> 00:05:56,720 EXCESS MORTALITY DURING THE 151 00:05:56,720 --> 00:05:58,120 PANDEMIC HAS BEEN OBSERVED 152 00:05:58,120 --> 00:06:00,280 RELATED TO COVID-19, BUT ALSO 153 00:06:00,280 --> 00:06:02,640 RELATED TO CARDIOVASCULAR 154 00:06:02,640 --> 00:06:03,720 CONDITIONS, DIABETES, AND 155 00:06:03,720 --> 00:06:11,520 DEMENTIA, AMONG MANY OTHERS. 156 00:06:11,520 --> 00:06:12,280 THE IMPLICATIONS OF THESE 157 00:06:12,280 --> 00:06:13,280 EFFECTS ARE LIKELY TO EXTEND 158 00:06:13,280 --> 00:06:15,160 INTO THE RECOVERY PHASE OF THE 159 00:06:15,160 --> 00:06:15,440 PANDEMIC. 160 00:06:15,440 --> 00:06:17,160 FOR EXAMPLE, THERE'S 161 00:06:17,160 --> 00:06:19,160 CONSIDERABLE ONGOING WORK TO 162 00:06:19,160 --> 00:06:21,440 ADDRESS A COVID-19-RELATED 163 00:06:21,440 --> 00:06:23,200 HEALTH DEBT THAT'S ACCUMULATED 164 00:06:23,200 --> 00:06:25,400 BECAUSE OF LESS HEALTHY 165 00:06:25,400 --> 00:06:27,120 BEHAVIORS AND FOREGONE MEDICAL 166 00:06:27,120 --> 00:06:30,240 CARE DURING THE PANDEMIC. 167 00:06:30,240 --> 00:06:31,600 ADDRESSING THESE CHRONIC 168 00:06:31,600 --> 00:06:33,840 CONDITIONS NOW CAN IMPROVE 169 00:06:33,840 --> 00:06:35,040 RESILIENCY AND PREPAREDNESS FOR 170 00:06:35,040 --> 00:06:36,120 THE NEXT PUBLIC HEALTH 171 00:06:36,120 --> 00:06:37,320 EMERGENCY. 172 00:06:37,320 --> 00:06:39,200 WHILE WE CAN'T KEEP PEOPLE FROM 173 00:06:39,200 --> 00:06:41,040 AGING, WE CAN DO THINGS SO THAT 174 00:06:41,040 --> 00:06:46,720 THEY'RE HEALTHY AS THEY AGE. 175 00:06:46,720 --> 00:06:48,040 NEXT LET'S TALK A LITTLE ABOUT 176 00:06:48,040 --> 00:06:49,680 AGING AND DISABILITY. 177 00:06:49,680 --> 00:06:51,760 SOME DISABILITIES INCREASE RISK 178 00:06:51,760 --> 00:06:53,560 OF INFECTION OR POOR OUTCOMES 179 00:06:53,560 --> 00:06:57,320 FROM COVID-19. 180 00:06:57,320 --> 00:06:59,200 FOR EXAMPLE, SOME PEOPLE MAY BE 181 00:06:59,200 --> 00:07:00,840 MORE LIKELY TO GET INFECTED OR 182 00:07:00,840 --> 00:07:02,920 HAVE SEVERE ILLNESS BECAUSE OF 183 00:07:02,920 --> 00:07:04,000 UNDERLYING MEDICAL CONDITIONS, 184 00:07:04,000 --> 00:07:09,680 CONJUGATE LIVING 185 00:07:09,680 --> 00:07:12,720 CONGREGATE LIVING SETTINGS OR 186 00:07:12,720 --> 00:07:14,400 SYSTEMIC HEALTH AND SOCIAL 187 00:07:14,400 --> 00:07:14,960 INEQUITIES. 188 00:07:14,960 --> 00:07:16,160 OTHER DISABILITIES MAY HAVE 189 00:07:16,160 --> 00:07:16,920 INTERFERED WITH HEALTH 190 00:07:16,920 --> 00:07:17,240 PROTECTION. 191 00:07:17,240 --> 00:07:18,680 THESE INCLUDE CHALLENGES WITH 192 00:07:18,680 --> 00:07:20,280 ACCESSING OR PROCESSING 193 00:07:20,280 --> 00:07:21,640 INFORMATION, OR ACCESSING 194 00:07:21,640 --> 00:07:28,600 HEALTHCARE AND OTHER ESSENTIAL 195 00:07:28,600 --> 00:07:30,200 SERVICES. 196 00:07:30,200 --> 00:07:32,000 IT'S CLEAR THAT DURING COVID-19, 197 00:07:32,000 --> 00:07:32,920 DISABILITY WASN'T ADDRESSED 198 00:07:32,920 --> 00:07:40,400 EARLY OR SYSTEMATICALLY ENOUGH. 199 00:07:40,400 --> 00:07:42,120 LAST, LET'S TALK ABOUT SOCIAL 200 00:07:42,120 --> 00:07:43,680 DETERMINANTS OF HEALTH. 201 00:07:43,680 --> 00:07:46,080 THE COVID-19 PANDEMIC 202 00:07:46,080 --> 00:07:47,640 UNDERSCORED HOW DIFFERENCES IN 203 00:07:47,640 --> 00:07:49,920 SOCIAL AND STRUCTURAL FACTORS 204 00:07:49,920 --> 00:07:52,200 HAVE SIGNIFICANT IMPACTS ON 205 00:07:52,200 --> 00:07:56,280 HEALTH AND ILLNESS. 206 00:07:56,280 --> 00:07:58,240 ISSUES LIKE OCCUPATION, POVERTY, 207 00:07:58,240 --> 00:07:59,920 HOUSING, PERSONAL SPACE, PLACES 208 00:07:59,920 --> 00:08:02,720 FOR PHYSICAL ACTIVITY, FOOD AND 209 00:08:02,720 --> 00:08:05,240 NUTRITION SECURITY, AND 210 00:08:05,240 --> 00:08:06,080 HEALTHCARE, AMONG MANY OTHERS, 211 00:08:06,080 --> 00:08:07,240 HAVE CONTRIBUTED TO DISPARITIES 212 00:08:07,240 --> 00:08:14,520 IN OUTCOMES OF COVID-19. 213 00:08:14,520 --> 00:08:16,240 SO WHAT NOW? 214 00:08:16,240 --> 00:08:18,680 WE HAVE LOTS OF TOOLS TO PROTECT 215 00:08:18,680 --> 00:08:19,680 OURSELVES AND OUR COMMUNITIES 216 00:08:19,680 --> 00:08:21,640 FROM SEVERE ILLNESS. 217 00:08:21,640 --> 00:08:24,320 THESE INCLUDE VACCINATIONS, 218 00:08:24,320 --> 00:08:25,120 BOOSTERS, AND EFFECTIVE 219 00:08:25,120 --> 00:08:27,760 TREATMENTS. 220 00:08:27,760 --> 00:08:29,120 CDC IS CONTINUING TO STREAMLINE 221 00:08:29,120 --> 00:08:31,960 AND SIMPLIFY ITS GUIDANCE, 222 00:08:31,960 --> 00:08:33,000 ACKNOWLEDGING THAT THE PANDEMIC 223 00:08:33,000 --> 00:08:34,680 IS NOT OVER AND PROVIDING PEOPLE 224 00:08:34,680 --> 00:08:36,520 WITH TOOLS TO PROTECT 225 00:08:36,520 --> 00:08:37,720 THEMSELVES, BUT ALSO HELPING US 226 00:08:37,720 --> 00:08:39,240 MOVE TO A POINT WHERE COVID-19 227 00:08:39,240 --> 00:08:41,800 NO LONGER SEVERELY DISRUPTS OUR 228 00:08:41,800 --> 00:08:46,920 DAILY LIVES. 229 00:08:46,920 --> 00:08:49,360 TOOLS TO PROTECT YOURSELF AND 230 00:08:49,360 --> 00:08:50,960 OTHERS INCLUDE HIGHLY EFFECTIVE 231 00:08:50,960 --> 00:08:56,000 VACCINES AND TREATMENTS, TREATM. 232 00:08:56,000 --> 00:08:57,000 VACCINATION REMAINS THE BEST WAY 233 00:08:57,000 --> 00:08:58,840 TO PROTECT FROM SEVERE COVID-19 234 00:08:58,840 --> 00:09:00,280 HOSPITALIZATION AND DEATH, AND 235 00:09:00,280 --> 00:09:01,880 COVID-19 VACCINES AND BOOSTERS 236 00:09:01,880 --> 00:09:06,040 ARE SAFE, EFFECTIVE, AND FREE. 237 00:09:06,040 --> 00:09:07,240 STRONGER PROTECTIONS ARE 238 00:09:07,240 --> 00:09:09,120 NECESSARY AT HIGH COMMUNITY 239 00:09:09,120 --> 00:09:10,400 LEVELS, AND FOR PEOPLE AT HIGHER 240 00:09:10,400 --> 00:09:12,400 RISK OF GETTING VERY SICK WITH 241 00:09:12,400 --> 00:09:13,680 COVID-19. 242 00:09:13,680 --> 00:09:14,680 THESE PROTECTIONS INCLUDE 243 00:09:14,680 --> 00:09:17,840 WEARING HIGH QUALITY MASKS, OR 244 00:09:17,840 --> 00:09:19,240 RESPIRATORS, AND EARLY ACCESS TO 245 00:09:19,240 --> 00:09:22,560 AND USE OF TREATMENTS QUICKLY 246 00:09:22,560 --> 00:09:28,280 AFTER INFECTION. 247 00:09:28,280 --> 00:09:29,720 THE NEXT STEP IS UNDERSTANDING 248 00:09:29,720 --> 00:09:30,120 YOUR RISK. 249 00:09:30,120 --> 00:09:31,200 THE THINGS WE'VE BEEN TALKING 250 00:09:31,200 --> 00:09:32,960 ABOUT THIS MORNING, LIKE OLDER 251 00:09:32,960 --> 00:09:35,480 AGE, HAVING A DISABILITY, A 252 00:09:35,480 --> 00:09:36,560 WEAKENED IMMUNE SYSTEM, AND 253 00:09:36,560 --> 00:09:37,960 CERTAIN HEALTH CONDITIONS 254 00:09:37,960 --> 00:09:39,600 INCREASE A PERSON'S RISK FOR 255 00:09:39,600 --> 00:09:42,800 SEVERE ILLNESS FROM COVID-19 AND 256 00:09:42,800 --> 00:09:44,760 WARRANT GREATER USE OF LAYERED 257 00:09:44,760 --> 00:09:49,240 PREVENTION STRATEGIES. 258 00:09:49,240 --> 00:09:50,560 WE SHOULD PROTECT OTHERS IF 259 00:09:50,560 --> 00:09:52,960 WE'RE EXPOSED. 260 00:09:52,960 --> 00:09:54,080 FOLLOW CDC'S RECOMMENDATIONS ON 261 00:09:54,080 --> 00:09:55,600 WHAT TO DO IF YOU'RE EXPOSED, 262 00:09:55,600 --> 00:09:57,240 INCLUDING WEARING A HIGH QUALITY 263 00:09:57,240 --> 00:09:58,680 MASK INDOORS AND AROUND OTHERS 264 00:09:58,680 --> 00:09:59,880 AS SOON AS YOU FIND OUT THAT YOU 265 00:09:59,880 --> 00:10:01,960 WERE EXPOSED. 266 00:10:01,960 --> 00:10:03,920 GET TESTED, AND WATCH CLOSELY 267 00:10:03,920 --> 00:10:09,480 FOR SYMPTOMS FOR 10 FULL DAYS. 268 00:10:09,480 --> 00:10:11,560 TAKE ACTION IF YOU'RE SICK TO 269 00:10:11,560 --> 00:10:12,600 PROTECT BOTH YOURSELF AND THE 270 00:10:12,600 --> 00:10:13,560 PEOPLE AROUND YOU. 271 00:10:13,560 --> 00:10:15,040 ASSURE EARLY ACCESS TO AND 272 00:10:15,040 --> 00:10:16,920 APPROPRIATE USE OF TREATMENTS. 273 00:10:16,920 --> 00:10:19,800 IF YOU HAVE SYMPTOMS, GET TESTED 274 00:10:19,800 --> 00:10:22,160 AND STAY HOME UNTIL YOU HAVE 275 00:10:22,160 --> 00:10:22,960 YOUR RESULTS. 276 00:10:22,960 --> 00:10:25,880 AND IF YOU HAVE TESTED POSITIVE, 277 00:10:25,880 --> 00:10:27,360 FOLLOW CDC'S ISOLATION 278 00:10:27,360 --> 00:10:28,080 RECOMMENDATIONS, INCLUDING 279 00:10:28,080 --> 00:10:28,960 STAYING HOME AND AWAY FROM 280 00:10:28,960 --> 00:10:30,680 OTHERS FOR AT LEAST 5 DAYS, 281 00:10:30,680 --> 00:10:32,400 WEARING A HIGH QUALITY MASK WHEN 282 00:10:32,400 --> 00:10:34,000 INDARS 283 00:10:34,000 --> 00:10:36,720 INDOORS AND AROUND OTHERS. 284 00:10:36,720 --> 00:10:39,920 I'LL FINISH WITH A COUPLE OF 285 00:10:39,920 --> 00:10:40,680 RESOURCES. 286 00:10:40,680 --> 00:10:42,560 SEARCH FIND HELP IS AN ONLINE 287 00:10:42,560 --> 00:10:43,560 LIBRARY WITH HUNDREDS OF 288 00:10:43,560 --> 00:10:44,840 RESOURCES FOR ORGANIZATIONS THAT 289 00:10:44,840 --> 00:10:47,160 SERVE OLDER ADULTS AND THEIR 290 00:10:47,160 --> 00:10:49,360 CAREGIVERS. 291 00:10:49,360 --> 00:10:51,200 WHAT IS ALZHEIMER'S DISEASE? 292 00:10:51,200 --> 00:10:52,200 AND EMERGENCY PREPAREDNESS FOR 293 00:10:52,200 --> 00:10:53,440 OLDER ADULTS, INCLUDING 294 00:10:53,440 --> 00:10:56,760 COVID-19. 295 00:10:56,760 --> 00:10:58,920 THANK YOU VERY MUCH, AND I WILL 296 00:10:58,920 --> 00:11:09,280 PASS THE BATON OVER. 297 00:11:13,960 --> 00:11:15,960 >> GOOD MORNING. 298 00:11:15,960 --> 00:11:18,680 I'D LIKE TO START BY THANKING 299 00:11:18,680 --> 00:11:20,200 THE WEBINAR ORGANIZERS FOR 300 00:11:20,200 --> 00:11:23,000 INVITING ME TO BE PART OF THIS 301 00:11:23,000 --> 00:11:24,680 IMPORTANT PANEL. 302 00:11:24,680 --> 00:11:26,160 MY NAME IS MARIA MARQUINE. 303 00:11:26,160 --> 00:11:27,480 I'M A FACULTY MEMBER AND 304 00:11:27,480 --> 00:11:29,400 SCIENTIST IN THE DIVISION OF 305 00:11:29,400 --> 00:11:31,520 GERIATRICS IN THE DEPARTMENT OF 306 00:11:31,520 --> 00:11:32,280 MEDICINE IN THE DUKE CENTER FOR 307 00:11:32,280 --> 00:11:34,520 THE STUDY OF AGING AND HUMAN 308 00:11:34,520 --> 00:11:35,680 DEVELOPMENT AT DUKE UNIVERSITY 309 00:11:35,680 --> 00:11:36,880 SCHOOL OF MEDICINE. 310 00:11:36,880 --> 00:11:38,800 IT'S A PLEASURE FOR ME TO BE 311 00:11:38,800 --> 00:11:39,920 HERE TODAY, AND I'M GOING TO BE 312 00:11:39,920 --> 00:11:42,680 SHARING WITH YOU WHAT REALLY WAS 313 00:11:42,680 --> 00:11:45,120 THE RESULT OF A LARGE EFFORT BY 314 00:11:45,120 --> 00:11:46,760 SEVERAL INVESTIGATORS IN THE 315 00:11:46,760 --> 00:11:48,960 UNITED STATES AND ACROSS LATIN 316 00:11:48,960 --> 00:11:50,520 AMERICA THAT CAME TOGETHER VERY 317 00:11:50,520 --> 00:11:53,160 EARLY ON DURING THE PANDEMIC 318 00:11:53,160 --> 00:11:57,960 UNDER THE MENTORSHIP OR THE 319 00:11:57,960 --> 00:11:59,240 LEADERSHIP OF HARVARD 320 00:11:59,240 --> 00:12:01,560 UNIVERSITY, WHO BROUGHT US 321 00:12:01,560 --> 00:12:03,440 TOGETHER TO UNDERSTAND, AS 322 00:12:03,440 --> 00:12:06,160 THINGS WERE HAPPENING, HOW THE 323 00:12:06,160 --> 00:12:07,800 PANDEMIC WAS CHANGING THE LIVES 324 00:12:07,800 --> 00:12:09,960 OF MIDDLE AND OLDER AGED ADULTS 325 00:12:09,960 --> 00:12:11,280 THAT ARE FROM UNDERSERVED 326 00:12:11,280 --> 00:12:12,680 COMMUNITIES AND OFTEN 327 00:12:12,680 --> 00:12:20,040 UNDERREPRESENTED IN RESEARCH. 328 00:12:20,040 --> 00:12:20,480 OKAY. 329 00:12:20,480 --> 00:12:30,640 SO BEFORE I SHARE MY WORK, I'D 330 00:12:30,640 --> 00:12:31,400 LIKE -- THANK YOU. 331 00:12:31,400 --> 00:12:32,600 NOW I HAVE ACCESS TO THE 332 00:12:32,600 --> 00:12:33,400 PRESENTATION. 333 00:12:33,400 --> 00:12:43,760 I APOLOGIZE FOR THAT. 334 00:12:46,120 --> 00:12:47,160 OKAY. 335 00:12:47,160 --> 00:12:47,920 I APOLOGIZE FOR THAT. 336 00:12:47,920 --> 00:12:49,000 SOME TECHNICAL DIFFICULTIES. 337 00:12:49,000 --> 00:12:50,000 OKAY. 338 00:12:50,000 --> 00:12:51,520 SO BEFORE I SHARE OUR WORK, I'D 339 00:12:51,520 --> 00:12:54,320 LIKE TO START BY SHARING SOME OF 340 00:12:54,320 --> 00:12:56,360 THE STATISTICS FROM THE CDC THAT 341 00:12:56,360 --> 00:12:59,400 SHOW THE NUMBER -- THE PERCENT 342 00:12:59,400 --> 00:13:05,400 OF COVID-19 CASES AND DEATH BY 343 00:13:05,400 --> 00:13:06,720 RACE/ETHNICITY OF PEOPLE AGE 344 00:13:06,720 --> 00:13:07,360 65 AND OLDER. 345 00:13:07,360 --> 00:13:08,920 SO WHAT YOU SEE REPRESENTED HERE 346 00:13:08,920 --> 00:13:10,800 IS THE DATA FOR THE OLDER ADULT 347 00:13:10,800 --> 00:13:13,520 POPULATION IN THE U.S. AS OF 348 00:13:13,520 --> 00:13:14,880 SEPTEMBER 2ND, SO JUST LAST 349 00:13:14,880 --> 00:13:16,040 WEEK. 350 00:13:16,040 --> 00:13:18,040 AND YOU SEE IT BROKEN DOWN BY 351 00:13:18,040 --> 00:13:20,320 THE MAIN RACIAL ETHNIC GROUPS IN 352 00:13:20,320 --> 00:13:20,920 THE UNITED STATES. 353 00:13:20,920 --> 00:13:22,600 SO IF YOU LOOK FOR EXAMPLE OVER 354 00:13:22,600 --> 00:13:25,240 HERE, THE HISPANIC LATINO 355 00:13:25,240 --> 00:13:26,840 POPULATION, WHAT IS REPRESENTED 356 00:13:26,840 --> 00:13:28,360 IN GREY IS THE PERCENT OF THE 357 00:13:28,360 --> 00:13:30,560 POPULATION AGED 65 AND OVER THAT 358 00:13:30,560 --> 00:13:33,200 IS LATINO IN THE U.S. OR 359 00:13:33,200 --> 00:13:34,040 HISPANIC. 360 00:13:34,040 --> 00:13:35,840 IN BLUE, WHAT YOU SEE ARE THE 361 00:13:35,840 --> 00:13:37,160 PROPORTION OF COVID-19 CASES 362 00:13:37,160 --> 00:13:40,120 THAT ARE FROM THIS RACIAL ETHNIC 363 00:13:40,120 --> 00:13:41,960 GROUP, AND IN RED, YOU SEE THE 364 00:13:41,960 --> 00:13:44,360 PROPORTION OF DEATHS ATTRIBUTED 365 00:13:44,360 --> 00:13:46,320 TO COVID-19 THAT ARE MEMBERS OF 366 00:13:46,320 --> 00:13:47,640 THIS GROUP. 367 00:13:47,640 --> 00:13:50,400 SO WHAT WE SEE IS A 368 00:13:50,400 --> 00:13:51,680 DISPROPORTIONATE IMPACT OF THE 369 00:13:51,680 --> 00:13:54,440 COVID-19 CASES IN DEATHS IN THE 370 00:13:54,440 --> 00:13:55,440 LATINO POPULATION. 371 00:13:55,440 --> 00:13:59,320 WE SEE SIMILAR TRENDS IN THE 372 00:13:59,320 --> 00:14:01,040 AMERICAN INDIAN/ALASKA NATIVE 373 00:14:01,040 --> 00:14:04,280 COMMUNITY AND THE 374 00:14:04,280 --> 00:14:05,680 BLACK/NON-LATINO COMMUNITY. 375 00:14:05,680 --> 00:14:07,680 OTHER GROUPS, WE SEE A LITTLE 376 00:14:07,680 --> 00:14:09,200 BIT LESS IMPACT RELATIVE TO THE 377 00:14:09,200 --> 00:14:10,520 PROPORTION OF THE POPULATION OF 378 00:14:10,520 --> 00:14:14,040 COVID-19 CASES AND DEATHS. 379 00:14:14,040 --> 00:14:15,760 ANOTHER WAY TO LOOK AT SOME OF 380 00:14:15,760 --> 00:14:21,240 THE DATA SHOWN BY THE CDC IS THE 381 00:14:21,240 --> 00:14:22,360 NUMBER OF DEATHS ASSOCIATED WITH 382 00:14:22,360 --> 00:14:22,640 COVID-19. 383 00:14:22,640 --> 00:14:25,080 THIS IS OVER TIME. 384 00:14:25,080 --> 00:14:26,920 SO I WANT TO POINT OUT A COUPLE 385 00:14:26,920 --> 00:14:27,480 OF THINGS HERE. 386 00:14:27,480 --> 00:14:28,880 I KNOW IT'S A BUSY SLIDE WITH 387 00:14:28,880 --> 00:14:33,040 LOTS OF DIFFERENT THINGS, BUT IF 388 00:14:33,040 --> 00:14:34,480 YOU LOOK AT THE HARD LINE HERE, 389 00:14:34,480 --> 00:14:37,360 THOSE ARE PEOPLE 75 AND OVER, 390 00:14:37,360 --> 00:14:38,520 AND THIS OTHER KIND OF DASHED 391 00:14:38,520 --> 00:14:43,560 LINE ARE PEOPLE -- SORRY, THIS 392 00:14:43,560 --> 00:14:48,200 IS 74 TO 5 CLASS AND 64 TO 393 00:14:48,200 --> 00:14:48,440 65 CLASS. 394 00:14:48,440 --> 00:14:50,640 SO WHAT YOU SEE IN ALL DIFFERENT 395 00:14:50,640 --> 00:14:52,840 RACIAL ETHNIC GROUPS IS 396 00:14:52,840 --> 00:14:54,720 DISPROPORTIONATE NUMBER OF 397 00:14:54,720 --> 00:14:55,480 DEATHS AMONG THE OLDER 398 00:14:55,480 --> 00:14:56,680 POPULATION AS WAS PREVIOUSLY 399 00:14:56,680 --> 00:14:57,760 MENTIONED, AND THE OTHER THING 400 00:14:57,760 --> 00:14:59,160 THAT YOU SEE OR THAT I'D LIKE TO 401 00:14:59,160 --> 00:15:00,040 POINT OUT IS THAT CERTAIN 402 00:15:00,040 --> 00:15:02,480 GROUPS, AGAIN, HAVE THE SPIKES 403 00:15:02,480 --> 00:15:04,960 THAT ARE MUCH LARGER THAN SOME 404 00:15:04,960 --> 00:15:05,720 OTHER GROUPS. 405 00:15:05,720 --> 00:15:08,360 AGAIN SHOWING HOW OVER TIME, THE 406 00:15:08,360 --> 00:15:09,680 NUMBER OF DEATHS HAVE CONTINUED 407 00:15:09,680 --> 00:15:11,520 TO BE INCREASED IN CERTAIN 408 00:15:11,520 --> 00:15:14,120 RACIAL OR ETHNIC GROUPS. 409 00:15:14,120 --> 00:15:16,200 AND THIS IS STILL THE CASE. 410 00:15:16,200 --> 00:15:19,320 SO AS I AGAIN MENTIONED THE 411 00:15:19,320 --> 00:15:20,520 PRIOR PRESENTATION BY DR. BRISS, 412 00:15:20,520 --> 00:15:22,760 THE PANDEMIC IS ONGOING. 413 00:15:22,760 --> 00:15:24,320 THERE'S STILL QUITE A BIT OF 414 00:15:24,320 --> 00:15:28,280 IMPACT, ESPECIALLY IN CERTAIN 415 00:15:28,280 --> 00:15:29,640 GROUPS OF OUR POPULATION. 416 00:15:29,640 --> 00:15:31,560 I WILL NOW START SHARING SOME OF 417 00:15:31,560 --> 00:15:32,520 THE FINDINGS AGAIN FROM OUR 418 00:15:32,520 --> 00:15:33,280 GROUP. 419 00:15:33,280 --> 00:15:34,720 IT'S A LARGE GROUP, AND THESE 420 00:15:34,720 --> 00:15:37,560 WERE PUBLISHED LAST YEAR, SOME 421 00:15:37,560 --> 00:15:41,080 OF THE THINGS I'M SHARING WITH 422 00:15:41,080 --> 00:15:41,360 YOU. 423 00:15:41,360 --> 00:15:42,960 WE WERE ABLE TO RECRUIT A GROUP 424 00:15:42,960 --> 00:15:45,000 OF CLOSE TO 900 COMMUNITY 425 00:15:45,000 --> 00:15:47,760 DWELLING ADULTS AGE 50-PLUS 426 00:15:47,760 --> 00:15:48,800 LIVING IN THE UNITED STATES. 427 00:15:48,800 --> 00:15:53,200 AS I MENTIONED BEFORE, WE ALSO 428 00:15:53,200 --> 00:15:56,440 HAD A NUMBER OF COUNTRIES IN 429 00:15:56,440 --> 00:15:56,840 LATIN AMERICA. 430 00:15:56,840 --> 00:15:58,320 I WILL FOCUS MY PRESENTATION ON 431 00:15:58,320 --> 00:15:59,640 THE U.S. SAMPLE. 432 00:15:59,640 --> 00:16:02,600 SO WE HAD PRIMARILY THREE 433 00:16:02,600 --> 00:16:04,480 MEMBERS OR THREE ETHNIC RACIAL 434 00:16:04,480 --> 00:16:07,200 GROUPS, WHITE, HISPANICS AND 435 00:16:07,200 --> 00:16:09,400 BLACKS, AND YOU SEE THE MEAN AGE 436 00:16:09,400 --> 00:16:14,440 WAS AROUND 65. 437 00:16:14,440 --> 00:16:15,640 PRETTY WELL -- A LIMITATION OF 438 00:16:15,640 --> 00:16:16,960 OUR FINDINGS, SOMETHING TO KEEP 439 00:16:16,960 --> 00:16:20,920 IN MIND, AND IT'S NOT COMPLETELY 440 00:16:20,920 --> 00:16:22,120 REPRESENTATIVE OF THE OVERALL 441 00:16:22,120 --> 00:16:23,360 POPULATION AND MOSTLY FEMALE. 442 00:16:23,360 --> 00:16:24,600 SO OUR PARTICIPANTS, 443 00:16:24,600 --> 00:16:25,920 PARTICIPANTS IN THIS STUDY, 444 00:16:25,920 --> 00:16:30,280 COMPLETED A SURVEY EITHER ONLINE 445 00:16:30,280 --> 00:16:32,240 OR BY PHONE BETWEEN MAY AND 446 00:16:32,240 --> 00:16:33,240 SEPTEMBER OF 2020, SO VERY EARLY 447 00:16:33,240 --> 00:16:35,680 ON IN THE PANDEMIC. 448 00:16:35,680 --> 00:16:39,680 WHERE THERE WAS A LOT OF 449 00:16:39,680 --> 00:16:40,520 UNCERTAINTY, OF COURSE THERE 450 00:16:40,520 --> 00:16:42,320 STILL IS A LOT OF UNANSWERED 451 00:16:42,320 --> 00:16:43,200 QUESTIONS, ESPECIALLY AT THAT 452 00:16:43,200 --> 00:16:44,320 TIME, A LOT OF THINGS WERE 453 00:16:44,320 --> 00:16:45,920 CLOSED DOWN AT THAT POINT. 454 00:16:45,920 --> 00:16:46,800 PARTICIPANTS COMPLETED THE 455 00:16:46,800 --> 00:16:50,520 SURVEY THAT ASKED FOR A NUMBER 456 00:16:50,520 --> 00:16:51,640 OF DIFFERENT MEASURES HAVING TO 457 00:16:51,640 --> 00:16:53,040 DO WITH WELL-BEING AND THE 458 00:16:53,040 --> 00:16:54,880 IMPACT ON PEOPLE'S LIVES. 459 00:16:54,880 --> 00:16:56,760 I'M GOING TO FOCUS ON TWO MAIN 460 00:16:56,760 --> 00:16:58,520 MEASURES THAT WE GATHERED. 461 00:16:58,520 --> 00:17:00,680 ONE WAS THE IMPACT OF THE 462 00:17:00,680 --> 00:17:02,000 PANDEMIC ON SEVERAL ASPECTS OF 463 00:17:02,000 --> 00:17:04,640 LIFE VIA THE EPIDEMIC PANDEMIC 464 00:17:04,640 --> 00:17:07,280 IMPACT INVENTORY, AND ALSO THE 465 00:17:07,280 --> 00:17:08,880 REPORT OF COGNITIVE SYMPTOMS OR 466 00:17:08,880 --> 00:17:11,200 COGNITIVE PROBLEMS AT THAT TIME 467 00:17:11,200 --> 00:17:13,360 RELATIVE TO BEFORE THE PANDEMIC. 468 00:17:13,360 --> 00:17:14,920 SO WHAT YOU SEE REPRESENTED HERE 469 00:17:14,920 --> 00:17:24,360 ARE FINDINGS FROM THE POTENTIAL 470 00:17:24,360 --> 00:17:28,480 INFECTION HISTORIMENT HIS. 471 00:17:28,480 --> 00:17:29,680 BACK THEN IT WAS HARD TO GET 472 00:17:29,680 --> 00:17:31,240 ACCESS TO TESTING IN CERTAIN 473 00:17:31,240 --> 00:17:32,080 POPULATIONS AND SO FORTH. 474 00:17:32,080 --> 00:17:33,840 I'LL SHOW IN THE NEXT FEW SLIDES 475 00:17:33,840 --> 00:17:35,160 SIMILAR GRAPHS AS THIS ONE FOR 476 00:17:35,160 --> 00:17:37,440 DIFFERENT DOMAINS OF LIFE, AND 477 00:17:37,440 --> 00:17:39,320 THE IMPACT OF THE PANDEMIC ON 478 00:17:39,320 --> 00:17:40,400 LIFE. 479 00:17:40,400 --> 00:17:41,440 IN GREY, YOU WILL SEE 480 00:17:41,440 --> 00:17:43,800 REPRESENTED THE NON-LATINO 481 00:17:43,800 --> 00:17:44,720 NON-HISPANIC WHITE GROUP, IN 482 00:17:44,720 --> 00:17:46,480 RED, THE HISPANIC LATINO GROUP, 483 00:17:46,480 --> 00:17:48,280 AND IN GREEN, NON-HISPANIC 484 00:17:48,280 --> 00:17:48,840 BLACKS. 485 00:17:48,840 --> 00:17:51,120 AND IN REFERS TO THEIR INFECTION 486 00:17:51,120 --> 00:17:51,440 HISTORY. 487 00:17:51,440 --> 00:17:53,400 THESE ARE THE ITEMS INCLUDED IN 488 00:17:53,400 --> 00:17:56,280 THIS SCALE. 489 00:17:56,280 --> 00:17:58,160 SO -- WHICH ARE BASICALLY HAVING 490 00:17:58,160 --> 00:17:59,120 SYMPTOMS WITH THE DISEASE, 491 00:17:59,120 --> 00:18:00,640 HAVING BEEN TESTED THINKING THEY 492 00:18:00,640 --> 00:18:01,600 MIGHT HAVE THE DISEASE. 493 00:18:01,600 --> 00:18:03,240 THIS EARLY ON IN OUR SAMPLE, WE 494 00:18:03,240 --> 00:18:07,320 ALREADY SAW THAT HISPANICS AND 495 00:18:07,320 --> 00:18:08,640 LATINOS HAD A WORSE INFECTION 496 00:18:08,640 --> 00:18:11,240 HISTORY COMPARED TO NON-LATINO 497 00:18:11,240 --> 00:18:12,440 WHITES AND A TREND IN BLACKS AS 498 00:18:12,440 --> 00:18:12,800 WELL. 499 00:18:12,800 --> 00:18:14,200 WHEN IT CAME TO THE ECONOMIC 500 00:18:14,200 --> 00:18:15,960 IMPACT OF THE PANDEMIC AT THAT 501 00:18:15,960 --> 00:18:17,880 POINT IN TIME, WE ALSO SAW THAT 502 00:18:17,880 --> 00:18:19,880 THERE WAS MORE FINANCIAL 503 00:18:19,880 --> 00:18:21,440 HARDSHIP AMONG HISPANIC LATINOS 504 00:18:21,440 --> 00:18:23,720 THAN NON-HISPANIC WHITES AND 505 00:18:23,720 --> 00:18:26,760 BLACKS AS ASSESSED BY THE 506 00:18:26,760 --> 00:18:27,560 SUBSCALE INCLUDING THESE ITEMS 507 00:18:27,560 --> 00:18:31,160 HERE AS YOU SEE LISTED, LIKE AN 508 00:18:31,160 --> 00:18:32,640 INABILITY TO GET ENOUGH FOOD OR 509 00:18:32,640 --> 00:18:34,320 HEALTHY FOOD, ACCESS CLEAN 510 00:18:34,320 --> 00:18:36,520 WATER, ET CETERA. 511 00:18:36,520 --> 00:18:38,600 SO LATINOS ARE REPORTING HAVING 512 00:18:38,600 --> 00:18:41,000 MORE TROUBLE WITH THIS, HAVING A 513 00:18:41,000 --> 00:18:41,840 GREATER ECONOMIC IMPACT AT THAT 514 00:18:41,840 --> 00:18:46,040 TIME. 515 00:18:46,040 --> 00:18:47,680 WE ALSO -- SORRY, THIS IS 516 00:18:47,680 --> 00:18:48,760 FREEZING UP AND I CANNOT 517 00:18:48,760 --> 00:18:58,520 ADVANCE. 518 00:18:58,520 --> 00:18:59,880 IT'S NOT LETTING ME ADVANCE. 519 00:18:59,880 --> 00:19:02,080 I'M NOT SURE IF I.T. WANTS TO 520 00:19:02,080 --> 00:19:02,960 TAKE CONTROL AND ADVANCE THE 521 00:19:02,960 --> 00:19:12,760 SLIDES? 522 00:19:12,760 --> 00:19:14,160 >> I NEED 10 SECONDS. 523 00:19:14,160 --> 00:19:14,800 I'M SORRY ABOUT THAT. 524 00:19:14,800 --> 00:19:15,720 >> NO PROBLEM. 525 00:19:15,720 --> 00:19:16,840 I'M SORRY TO THE AUDIENCE ABOUT 526 00:19:16,840 --> 00:19:17,960 IT. 527 00:19:17,960 --> 00:19:19,640 HOPEFULLY WE'LL GET GOING FAIRLY 528 00:19:19,640 --> 00:19:29,720 SOON. 529 00:19:32,400 --> 00:19:33,480 SO AS THE TECHNICAL DIFFICULTIES 530 00:19:33,480 --> 00:19:35,240 ARE BEING SORTED OUT, I THINK, 531 00:19:35,240 --> 00:19:39,280 YOU KNOW, OVERALL, SOME OF OUR 532 00:19:39,280 --> 00:19:42,480 SLIDES, WHAT ARE SHOWING AT THIS 533 00:19:42,480 --> 00:19:44,040 POINT IS THIS DISPROPORTIONATE 534 00:19:44,040 --> 00:19:45,120 IMPACT OF THE PANDEMIC IN THE 535 00:19:45,120 --> 00:19:47,400 LIVES OF PEOPLE FROM 536 00:19:47,400 --> 00:19:48,440 UNDERREPRESENTED MINORITIZED 537 00:19:48,440 --> 00:19:50,120 GROUPS IN THE U.S., SO WE KNOW 538 00:19:50,120 --> 00:19:53,040 THAT THE PANDEMIC IMPACTED 539 00:19:53,040 --> 00:19:55,800 BASICALLY THE LIFE OF EVERYONE 540 00:19:55,800 --> 00:19:58,640 IN ONE WAY OR ANOTHER. 541 00:19:58,640 --> 00:20:00,360 BUT IT WAS -- THIS IMPACT HAS 542 00:20:00,360 --> 00:20:02,360 BEEN DISPROPORTIONATE IN CERTAIN 543 00:20:02,360 --> 00:20:04,120 GROUPS, AND THE SOCIOCULTURAL 544 00:20:04,120 --> 00:20:06,800 CONTEXT IS IMPORTANT TO KEEP IN 545 00:20:06,800 --> 00:20:11,560 MIND AS WE SEE VAL WAIT WHAT HAS 546 00:20:11,560 --> 00:20:12,840 BEEN THE IMPACT OF THE PANDEMIC 547 00:20:12,840 --> 00:20:14,680 AND WHAT MIGHT CONTINUE TO BE IN 548 00:20:14,680 --> 00:20:15,920 THE FUTURE. 549 00:20:15,920 --> 00:20:20,120 SO I THINK NOW I HAVE ACCESS 550 00:20:20,120 --> 00:20:20,560 AGAIN. 551 00:20:20,560 --> 00:20:21,080 LET ME SEE. 552 00:20:21,080 --> 00:20:21,600 I DO. 553 00:20:21,600 --> 00:20:22,280 THANK YOU FOR THAT. 554 00:20:22,280 --> 00:20:24,920 SO WE WERE HERE IN THE ECONOMIC 555 00:20:24,920 --> 00:20:25,160 IMPACT. 556 00:20:25,160 --> 00:20:25,960 I'LL MOVE FORWARD TO THE NEXT 557 00:20:25,960 --> 00:20:27,960 ONE. 558 00:20:27,960 --> 00:20:29,880 SO ANOTHER SCALE EVALUATED THE 559 00:20:29,880 --> 00:20:31,160 IMPACT OF THE PANDEMIC ON 560 00:20:31,160 --> 00:20:32,360 PEOPLE'S HOME LIFE, AND AGAIN 561 00:20:32,360 --> 00:20:34,960 YOU SEE THE ITEMS IN THE SCALE 562 00:20:34,960 --> 00:20:35,720 REPRESENTED HERE TO GIVE YOU A 563 00:20:35,720 --> 00:20:38,520 SENSE OF HOW THIS WAS ASSESSED. 564 00:20:38,520 --> 00:20:42,760 SO THERE'S VERY DIFFERENT IN 565 00:20:42,760 --> 00:20:45,480 MANY WAYS BUT INCREASE IN VERBAL 566 00:20:45,480 --> 00:20:46,560 ARGUMENTS, PHYSICAL CONFLICTS 567 00:20:46,560 --> 00:20:48,040 WITH SPOUSES, PARTNERS, OTHER 568 00:20:48,040 --> 00:20:51,240 PEOPLE IN THE HOMEMENT HOM. 569 00:20:51,240 --> 00:20:53,120 AND WHAT WE SAW FOR THIS SCALE 570 00:20:53,120 --> 00:20:55,200 IS THAT AMONG NON-LATINO AND 571 00:20:55,200 --> 00:20:56,520 NON-HISPANIC BLACKS, THIS 572 00:20:56,520 --> 00:20:58,160 CHANGES IN HOME LIFE, NEGATIVE 573 00:20:58,160 --> 00:21:01,120 CHANGES IN HOME LIFE HAPPENED 574 00:21:01,120 --> 00:21:02,920 MORE OFTEN OR MORE FREQUENTLY 575 00:21:02,920 --> 00:21:06,560 THAN FOR OTHER GROUPS. 576 00:21:06,560 --> 00:21:08,520 HERE THE SCALE ASSESSED THE 577 00:21:08,520 --> 00:21:09,720 LIMITATIONS IN SOCIAL ACTIVITIES 578 00:21:09,720 --> 00:21:11,280 AND HAVING TO DISTANCE 579 00:21:11,280 --> 00:21:12,560 PHYSICALLY, WHICH WAS QUITE 580 00:21:12,560 --> 00:21:13,480 PREVALENT AT THAT POINT. 581 00:21:13,480 --> 00:21:17,360 THERE WERE NO SIGNIFICANT GROUP 582 00:21:17,360 --> 00:21:18,160 DIFFERENCES BUT EVERYBODY WAS 583 00:21:18,160 --> 00:21:19,520 HAVING TO DO THAT QUITE A BIT AT 584 00:21:19,520 --> 00:21:22,880 THAT TIME. 585 00:21:22,880 --> 00:21:24,840 THEN EMOTIONAL HEALTH, WE DIDN'T 586 00:21:24,840 --> 00:21:25,920 SEE SIGNIFICANT DIFFERENCES 587 00:21:25,920 --> 00:21:27,240 ACROSS GROUPS, BUT WE DID SEE 588 00:21:27,240 --> 00:21:31,040 THAT A LOT OF PEOPLE WERE 589 00:21:31,040 --> 00:21:33,480 ENDORSING CHANGES IN EMOTIONAL 590 00:21:33,480 --> 00:21:34,480 HEALTH, BOTH FOR THEMSELVES AND 591 00:21:34,480 --> 00:21:36,760 PEOPLE LIVING WITH THEM, 592 00:21:36,760 --> 00:21:37,960 INCREASING MENTAL HEALTH 593 00:21:37,960 --> 00:21:38,920 PROBLEMS, INCREASING SLEEP 594 00:21:38,920 --> 00:21:39,880 PROBLEMS, ALCOHOL OR SUBSTANCE 595 00:21:39,880 --> 00:21:41,040 USE. 596 00:21:41,040 --> 00:21:43,120 SO QUITE NOTABLE. 597 00:21:43,120 --> 00:21:44,720 SAME THING FOR PHYSICAL HEALTH, 598 00:21:44,720 --> 00:21:46,040 NO SIGNIFICANT GROUP 599 00:21:46,040 --> 00:21:52,080 DIFFERENCES, BUT STILL, NOTABLE 600 00:21:52,080 --> 00:21:53,960 CHANGES NOTED ACROSS MANY 601 00:21:53,960 --> 00:21:57,200 DIFFERENT SEGMENTS OF THE 602 00:21:57,200 --> 00:21:59,080 POPULATION AS LISTED HERE, LIKE 603 00:21:59,080 --> 00:22:00,520 INCREASING HEALTH PROBLEMS NOT 604 00:22:00,520 --> 00:22:02,800 RELATED TO THE DISEASE, LESS 605 00:22:02,800 --> 00:22:06,640 PHYSICAL ACTIVITY, ET CETERA. 606 00:22:06,640 --> 00:22:08,160 THIS SLIDE, I'D LIKE TO SPEND A 607 00:22:08,160 --> 00:22:09,120 LITTLE BIT MORE TIME ON. 608 00:22:09,120 --> 00:22:10,320 WHAT I'VE BEEN DISCUSSING UP 609 00:22:10,320 --> 00:22:12,880 UNTIL NOW ARE MOSTLY CAPTURED 610 00:22:12,880 --> 00:22:14,480 UNDER THE UMBRELLA OF NEGATIVE 611 00:22:14,480 --> 00:22:19,400 IMPACTS ON DAILY LIFE OF PEOPLE. 612 00:22:19,400 --> 00:22:23,160 NOW, WHAT THIS SUBSCALE SAYS IS 613 00:22:23,160 --> 00:22:23,920 POSITIVE LIFE CHANGES ASSOCIATED 614 00:22:23,920 --> 00:22:27,080 WITH THE PANDEMIC. 615 00:22:27,080 --> 00:22:28,720 LIKE MORE QUALITY TIME WITH 616 00:22:28,720 --> 00:22:31,640 FAMILY MEMBERS OR FRIENDS, 617 00:22:31,640 --> 00:22:34,520 CHILDREN OR SPOUSES, IMPROVED 618 00:22:34,520 --> 00:22:35,640 RELATIONSHIPS, MORE TIME IN 619 00:22:35,640 --> 00:22:37,160 NATURE AND SO FORTH. 620 00:22:37,160 --> 00:22:39,320 WHAT WE SAW WAS THAT BOTH FOR 621 00:22:39,320 --> 00:22:43,200 THE HISPANIC LATINOS AND THE 622 00:22:43,200 --> 00:22:45,440 NON-LATINO BLACKS IN OUR 623 00:22:45,440 --> 00:22:46,280 SAMPLES, THESE GROUPS REPORTED 624 00:22:46,280 --> 00:22:47,480 MORE POSITIVE CHANGE ASSOCIATED 625 00:22:47,480 --> 00:22:50,160 WITH THE PANDEMIC, WHICH IS 626 00:22:50,160 --> 00:22:52,560 SOMEWHAT STRIKING, GIVEN THAT 627 00:22:52,560 --> 00:22:56,960 EITHER LATINOS OR BLACKS HAD A 628 00:22:56,960 --> 00:22:58,680 LOT OF OTHER IMPACTS OF THE 629 00:22:58,680 --> 00:22:59,960 PANDEMIC THAT WERE NEGATIVE. 630 00:22:59,960 --> 00:23:02,800 SO THIS WAS SOME POSITIVE THINGS 631 00:23:02,800 --> 00:23:05,160 THAT WERE NOTED. 632 00:23:05,160 --> 00:23:06,440 AS I MENTIONED BRIEFLY BEFORE, 633 00:23:06,440 --> 00:23:11,920 WE ALSO ASSESSED SELF-REPORT OF 634 00:23:11,920 --> 00:23:14,040 COMMON SYMPTOMS, IN THIS CASE, 635 00:23:14,040 --> 00:23:15,640 PEOPLE REPORTING PROBLEMS WITH 636 00:23:15,640 --> 00:23:17,840 MEMORY, THINKING, AND OTHER 637 00:23:17,840 --> 00:23:19,040 PROCESSING SPEED, OTHER SKILLS. 638 00:23:19,040 --> 00:23:22,520 WE SAW THAT ACTUALLY NON-LATINO 639 00:23:22,520 --> 00:23:24,200 WHITES REPORTED MORE COGNITIVE 640 00:23:24,200 --> 00:23:26,080 SYMPTOMS THAN HISPANIC LATINOS 641 00:23:26,080 --> 00:23:27,280 AND BLACKS. 642 00:23:27,280 --> 00:23:28,360 AND GREATER NEGATIVE IMPACT OF 643 00:23:28,360 --> 00:23:31,400 THE PANDEMIC WAS ASSOCIATED WITH 644 00:23:31,400 --> 00:23:32,760 MORE COGNITIVE SYMPTOMS ACROSS 645 00:23:32,760 --> 00:23:33,720 GROUPS. 646 00:23:33,720 --> 00:23:36,040 SO BASICALLY THE MORE RELATED 647 00:23:36,040 --> 00:23:37,120 LIFE CHANGES, THE MORE THAT 648 00:23:37,120 --> 00:23:39,840 PEOPLE WERE NOTICING COGNITIVE 649 00:23:39,840 --> 00:23:41,160 CHANGES OR CHANGES IN THINKING 650 00:23:41,160 --> 00:23:44,120 OR MEMORY, WHICH CAN BE IN SOME 651 00:23:44,120 --> 00:23:46,840 CASES A PRECURSOR FOR MORE 652 00:23:46,840 --> 00:23:48,480 IMPORTANT PROBLEMS LIKE 653 00:23:48,480 --> 00:23:48,920 ALZHEIMER'S DISEASE. 654 00:23:48,920 --> 00:23:50,240 I'M GOING TO SHARE VERY BRIEFLY 655 00:23:50,240 --> 00:23:52,280 SOME OF OUR RESULTS OF OUR LATIN 656 00:23:52,280 --> 00:23:54,960 AMERICAN SAMPLE, WHICH IS THE 657 00:23:54,960 --> 00:23:56,120 DEMOGRAPHICS ARE DEPICTED HERE, 658 00:23:56,120 --> 00:24:05,360 SO AGAIN, THEY WERE PEOPLE 50 659 00:24:05,360 --> 00:24:06,200 PLUS, PRIMARILY FEMALE, YOU SEE 660 00:24:06,200 --> 00:24:08,720 SOME OF THE STATISTICS THERE. 661 00:24:08,720 --> 00:24:10,600 A NUMBER OF COUNTRIES IN SOUTH 662 00:24:10,600 --> 00:24:12,440 AMERICA, CENTRAL AMERICA AND THE 663 00:24:12,440 --> 00:24:12,880 CARIBBEAN. 664 00:24:12,880 --> 00:24:16,480 THE MAIN REASON WHY I'M KIND OF 665 00:24:16,480 --> 00:24:17,680 GIVING YOU A GLIMPSE OF THIS 666 00:24:17,680 --> 00:24:19,640 SAMPLE, THESE FINDINGS 667 00:24:19,640 --> 00:24:20,760 REPRESENTED AT THE ALZHEIMER'S 668 00:24:20,760 --> 00:24:22,480 ASSOCIATION INTERNATIONAL 669 00:24:22,480 --> 00:24:24,480 CONFERENCE IS THAT WE LOOKED AT 670 00:24:24,480 --> 00:24:28,400 THE DATA IN A SOMEWHAT DIFFERENT 671 00:24:28,400 --> 00:24:29,160 WAY, INVESTIGATING WHAT WAS BOTH 672 00:24:29,160 --> 00:24:32,720 THE NEGATIVE AND POSITIVE, HOW 673 00:24:32,720 --> 00:24:33,960 DID BOTH NEGATIVE AND POSITIVE 674 00:24:33,960 --> 00:24:36,880 LIFE CHANGES IMPACT COGNITIVE 675 00:24:36,880 --> 00:24:38,800 SYMPTOMS IN THIS OLDER SAMPLE? 676 00:24:38,800 --> 00:24:40,120 WHAT WE SAW IS THAT SIMILAR TO 677 00:24:40,120 --> 00:24:43,080 WHAT WE HAD SEEN IN OUR U.S. 678 00:24:43,080 --> 00:24:44,600 SAMPLE, MORE NEGATIVE LIFE 679 00:24:44,600 --> 00:24:46,800 CHANGES WERE ASSOCIATED WITH 680 00:24:46,800 --> 00:24:49,400 MORE COGNITIVE SYMPTOMS, MORE 681 00:24:49,400 --> 00:24:50,920 COGNITIVE PROBLEMS. 682 00:24:50,920 --> 00:24:52,120 HOWEVER, THIS ASSOCIATION WAS 683 00:24:52,120 --> 00:24:54,840 MUCH WEAKER IN PEOPLE THAT 684 00:24:54,840 --> 00:24:57,080 REPORTED AT LEAST ONE POSITIVE 685 00:24:57,080 --> 00:24:57,920 THING ASSOCIATED WITH THE 686 00:24:57,920 --> 00:25:01,640 CURRENT PANDEMIC. 687 00:25:01,640 --> 00:25:03,320 SUGGESTING THAT BEING ABLE TO 688 00:25:03,320 --> 00:25:05,400 EXPERIENCE AT LEAST ONE POSITIVE 689 00:25:05,400 --> 00:25:07,120 CHANGE CAN SIGNIFICANTLY BUFFER 690 00:25:07,120 --> 00:25:10,280 THE NEGATIVE IMPACT OF NEGATIVE 691 00:25:10,280 --> 00:25:13,480 THINGS HAPPENING IN YOUR LIFE 692 00:25:13,480 --> 00:25:14,880 WITH THE ONSET OF COGNITIVE 693 00:25:14,880 --> 00:25:18,200 PROBLEMS. 694 00:25:18,200 --> 00:25:21,080 SO TO CONCLUDE, WE OBSERVED 695 00:25:21,080 --> 00:25:22,760 RACIAL ETHNIC DIFFERENCES ON THE 696 00:25:22,760 --> 00:25:24,200 IMPACT OF COVID-19 PANDEMIC IN 697 00:25:24,200 --> 00:25:27,720 OUR U.S. SAMPLE IN THE LIVES OF 698 00:25:27,720 --> 00:25:30,080 PEOPLE WITH USUALLY MINORITIZED 699 00:25:30,080 --> 00:25:33,280 GROUP PRESENTING WITH A MORE 700 00:25:33,280 --> 00:25:34,120 INCREASED NEGATIVE IMPACT OF THE 701 00:25:34,120 --> 00:25:36,960 PANDEMIC ON THEIR LIVES, BUT 702 00:25:36,960 --> 00:25:39,840 DESPITE THIS, THESE GROUPS ALSO 703 00:25:39,840 --> 00:25:41,040 REPORTED -- WERE MORE LIKELY TO 704 00:25:41,040 --> 00:25:42,360 REPORT POSITIVE LIFE CHANGES 705 00:25:42,360 --> 00:25:43,480 ASSOCIATED WITH THE PANDEMIC AS 706 00:25:43,480 --> 00:25:45,760 WELL. 707 00:25:45,760 --> 00:25:49,160 ONE MORE NEGATIVE, LIFE CHANGES 708 00:25:49,160 --> 00:25:51,720 RELATED TO MORE COGNITIVE 709 00:25:51,720 --> 00:25:52,760 SYMPTOMS. 710 00:25:52,760 --> 00:25:56,040 THIS ASSOCIATION WAS 711 00:25:56,040 --> 00:25:58,240 CONSIDERABLY LESS STRONG IN 712 00:25:58,240 --> 00:25:59,760 PEOPLE WITH POSITIVE LIFE 713 00:25:59,760 --> 00:26:01,520 CHANGES THAT WERE ABLE TO 714 00:26:01,520 --> 00:26:01,760 REPORT. 715 00:26:01,760 --> 00:26:03,800 SO OUR STUDIES, OF COURSE, HAVE 716 00:26:03,800 --> 00:26:05,080 SOME LIMITATIONS, LIKE THIS IS 717 00:26:05,080 --> 00:26:07,520 NOT A POPULATION-BASED STUDY. 718 00:26:07,520 --> 00:26:09,360 IT'S A SAMPLE OF -- WHAT WE CALL 719 00:26:09,360 --> 00:26:11,560 A SAMPLE OF CONVENIENCE, AND WE 720 00:26:11,560 --> 00:26:15,680 AT THIS POINT HAVE SELF-REPORTED 721 00:26:15,680 --> 00:26:16,120 COGNITIVE SYMPTOMS. 722 00:26:16,120 --> 00:26:17,360 SOME OF THE FUTURE DIRECTIONS 723 00:26:17,360 --> 00:26:18,440 THAT WE ARE EXPLORING RIGHT NOW 724 00:26:18,440 --> 00:26:20,400 ARE TO EXAMINE THE LONG TERM 725 00:26:20,400 --> 00:26:22,800 IMPACT OF THE PAN PANDEMIC ON 726 00:26:22,800 --> 00:26:23,040 COGNITION. 727 00:26:23,040 --> 00:26:24,440 THIS IS AN ONGOING STUDY, SO 728 00:26:24,440 --> 00:26:26,000 WE'LL BE ABLE TO LOOK OVER TIME 729 00:26:26,000 --> 00:26:27,840 HOW THINGS HAVE CHANGED IN TERMS 730 00:26:27,840 --> 00:26:29,440 OF HOW THOSE EARLY IMPACTS OF 731 00:26:29,440 --> 00:26:31,120 THE PANDEMIC IMPACTED COGNITION 732 00:26:31,120 --> 00:26:33,080 DOWN THE LINE AND WE'RE 733 00:26:33,080 --> 00:26:34,440 INCLUDING PERFORMANCE-BASED 734 00:26:34,440 --> 00:26:37,120 OBJECTIVE MEASURES FOR 735 00:26:37,120 --> 00:26:38,360 PERMISSION IN A SUBSET OF THE 736 00:26:38,360 --> 00:26:38,760 SAMPLE. 737 00:26:38,760 --> 00:26:40,200 SO WITH THAT, I'D LIKE TO WRAP 738 00:26:40,200 --> 00:26:42,840 UP BY THANKING YOU FOR BEING 739 00:26:42,840 --> 00:26:46,640 PART OF THIS, AND THE 740 00:26:46,640 --> 00:26:47,560 INTERNATIONAL GROUP OF 741 00:26:47,560 --> 00:26:49,160 INVESTIGATORS IS VERY LARGE AND 742 00:26:49,160 --> 00:26:55,080 OUR FUNDERS AT MASSACHUSETTS 743 00:26:55,080 --> 00:26:56,400 GENERAL HOSPITAL COMMITTEE ON 744 00:26:56,400 --> 00:26:57,800 RESEARCH, A PHILANTHROPIC GIFT 745 00:26:57,800 --> 00:26:59,440 TO THE UNIVERSITY OF CALIFORNIA 746 00:26:59,440 --> 00:27:01,200 SAN DIEGO WHERE I WAS WHEN I 747 00:27:01,200 --> 00:27:03,640 CONDUCTED THIS WORK, AND ALSO 748 00:27:03,640 --> 00:27:09,640 YOU'RE GUY 749 00:27:09,640 --> 00:27:10,080 URUGUAY. 750 00:27:10,080 --> 00:27:11,160 SO THANK YOU VERY MUCH AND I'LL 751 00:27:11,160 --> 00:27:12,360 LEAVE IT UP TO THE NEXT 752 00:27:12,360 --> 00:27:22,560 PRESENTER. 753 00:27:23,160 --> 00:27:24,080 >> GREAT, THANK YOU. 754 00:27:24,080 --> 00:27:25,480 I THINK I HAVE CONTROL, I 755 00:27:25,480 --> 00:27:25,800 BELIEVE. 756 00:27:25,800 --> 00:27:29,080 SO MY NAME IS JENNIFER FRONTERA, 757 00:27:29,080 --> 00:27:31,280 AND I AM A NEUROLOGIST, I 758 00:27:31,280 --> 00:27:32,720 SPECIALIZE IN STROKE AND 759 00:27:32,720 --> 00:27:33,880 NEUROCRITICAL CARE, AND I ALSO 760 00:27:33,880 --> 00:27:35,120 WORK CLOSELY WITH OUR 761 00:27:35,120 --> 00:27:36,000 ALZHEIMER'S DISEASE RESEARCH 762 00:27:36,000 --> 00:27:42,800 CENTER AT NYU ON COVID-RELATED 763 00:27:42,800 --> 00:27:50,320 COGNITION. 764 00:27:50,320 --> 00:27:52,520 I AM BATTLING SOMEONE ELSE WITH 765 00:27:52,520 --> 00:27:54,240 THE MOUSE, BUT -- OKAY. 766 00:27:54,240 --> 00:27:56,080 THESE ARE SOME DISCLOSURES. 767 00:27:56,080 --> 00:28:00,600 I HAVE A VARIETY OF GRANTS AND 768 00:28:00,600 --> 00:28:01,720 DIFFERENT NIH INSTITUTIONS 769 00:28:01,720 --> 00:28:03,600 RELATED TO COVID AND I SIT ON 770 00:28:03,600 --> 00:28:12,840 THE TASK FORCE FOR COVID-19. 771 00:28:12,840 --> 00:28:13,240 THANK YOU. 772 00:28:13,240 --> 00:28:14,040 I THINK I HAVE CONTROL NOW. 773 00:28:14,040 --> 00:28:15,080 THANK YOU. 774 00:28:15,080 --> 00:28:16,480 SO I'M GOING TO START OFF 775 00:28:16,480 --> 00:28:18,760 TALKING ABOUT SOME OF THE 776 00:28:18,760 --> 00:28:20,640 STUDIES WE'VE DONE AT NYU, AND 777 00:28:20,640 --> 00:28:22,720 AGAIN, THERE'S AN IMMENSE 778 00:28:22,720 --> 00:28:24,680 LITERATURE NOW AT THIS POINT 779 00:28:24,680 --> 00:28:27,720 LOOKING AT NEUROLOGICAL EVENTS 780 00:28:27,720 --> 00:28:30,040 FOLLOWING COVID, WAY TOO MUCH TO 781 00:28:30,040 --> 00:28:33,080 DISCUSS IN ONE BRIEF TALK, SO 782 00:28:33,080 --> 00:28:34,280 I'M JUST GOING TO FOCUS ON SOME 783 00:28:34,280 --> 00:28:36,160 OF THE WORK THAT WE HAVE DONE. 784 00:28:36,160 --> 00:28:38,800 SO DURING THE FIRST WAVE OF 785 00:28:38,800 --> 00:28:43,080 COVID IN NEW YORK CITY, WE WERE 786 00:28:43,080 --> 00:28:45,560 ABLE TO ORGANIZE A PROSPECTIVE 787 00:28:45,560 --> 00:28:46,760 STUDY OF PATIENTS HOSPITALIZED 788 00:28:46,760 --> 00:28:48,280 BETWEEN MARCH AND MAY AT OUR 789 00:28:48,280 --> 00:28:50,080 HOSPITALS, AND WE BASICALLY 790 00:28:50,080 --> 00:28:51,280 LOOKED THROUGH EVERYONE THAT WAS 791 00:28:51,280 --> 00:28:55,320 TOUCHED BY A NEUROLOGY TEAM AND 792 00:28:55,320 --> 00:28:57,720 IDENTIFIED PATIENTS THAT HAD IN 793 00:28:57,720 --> 00:28:59,120 NEUROLOGICAL EVENTS RELATED TO 794 00:28:59,120 --> 00:29:00,440 THEIR COVID ADMISSION. 795 00:29:00,440 --> 00:29:02,000 THEN WE FOLLOWED THESE FOLKS OUT 796 00:29:02,000 --> 00:29:03,360 AT 6 AND 12 MONTHS AND MADE 797 00:29:03,360 --> 00:29:05,240 PHONE CALLS TO DO A VARIETY OF 798 00:29:05,240 --> 00:29:06,800 DIFFERENT BATTERIES, CHECKING 799 00:29:06,800 --> 00:29:08,000 THEIR FUNCTIONAL STATUS AND 800 00:29:08,000 --> 00:29:10,720 COGNITIVE STA STATUS, AS WELLS 801 00:29:10,720 --> 00:29:13,800 NEUROPSYCHIATRIC FUNCTIONING. 802 00:29:13,800 --> 00:29:16,440 SO WE INITIALLY ENROLLED ABOUT 803 00:29:16,440 --> 00:29:17,480 4500 PATIENTS DURING THIS 804 00:29:17,480 --> 00:29:18,920 TWO-MONTH EPIC, AND WE 805 00:29:18,920 --> 00:29:21,320 IDENTIFIED ABOUT 14% THAT HAD A 806 00:29:21,320 --> 00:29:23,880 NEW NEUROLOGICAL DIAGNOSIS 807 00:29:23,880 --> 00:29:25,040 DURING THEIR HOSPITALIZATION, 808 00:29:25,040 --> 00:29:29,520 AND COMPARED THEM TO 3,885 THAT 809 00:29:29,520 --> 00:29:30,640 DID NOT. 810 00:29:30,640 --> 00:29:34,680 WE THEN LOOKED AT SURVIVORS 811 00:29:34,680 --> 00:29:37,640 PROPENSITY SCORES. 812 00:29:37,640 --> 00:29:41,160 WE HAD ABOUT 382 AT 6 MONTHS, 813 00:29:41,160 --> 00:29:45,720 242 AT 12 MONTHS, AND A TOTAL OF 814 00:29:45,720 --> 00:29:47,160 481 UNIQUE PATIENTS AT EITHER OF 815 00:29:47,160 --> 00:29:47,680 THOSE TIME POINTS. 816 00:29:47,680 --> 00:29:51,840 SO WHAT WE FOUND DURING 817 00:29:51,840 --> 00:29:53,400 HOSPITALIZATION WAS THAT THE 818 00:29:53,400 --> 00:29:54,480 MOST COMMON EVENT WAS REALLY 819 00:29:54,480 --> 00:29:58,080 WHAT WE CALL TOXICS METABOLIC 820 00:29:58,080 --> 00:30:00,520 ENCEPHALOPATHY WHICH AFFECTED 821 00:30:00,520 --> 00:30:01,560 CONFUSION AND WE LOOKED AT 822 00:30:01,560 --> 00:30:02,720 PATIENTS WHO WERE NOT CONFUSED 823 00:30:02,720 --> 00:30:03,760 BECAUSE THEY WERE GETTING 824 00:30:03,760 --> 00:30:04,840 SEDATION, THEY WERE CONFUSED 825 00:30:04,840 --> 00:30:06,720 BECAUSE THEY HAD SOME FORM OF 826 00:30:06,720 --> 00:30:08,480 BRAIN INJURY, EITHER DUE TO AN 827 00:30:08,480 --> 00:30:10,880 INFECTION, LOW OXYGEN LEVELS, 828 00:30:10,880 --> 00:30:12,680 KIDNEY FAILURE, ET CETERA, AND 829 00:30:12,680 --> 00:30:14,480 THIS WAS BY FAR THE MOST COMMON 830 00:30:14,480 --> 00:30:16,360 THING THAT WE OBSERVED, AND HAS 831 00:30:16,360 --> 00:30:17,560 SUBSEQUENTLY BEEN OBSERVED IN 832 00:30:17,560 --> 00:30:18,960 MULTIPLE OTHER COHORTS. 833 00:30:18,960 --> 00:30:21,840 WE ALSO SAW ISCHEMIC STROKE, 834 00:30:21,840 --> 00:30:24,040 HEMORRHAGES, SEIZURES AND A 835 00:30:24,040 --> 00:30:25,760 VARIETY OF OTHER THINGS, BUT 836 00:30:25,760 --> 00:30:27,280 MOSTLY DOMINATED BY THIS 837 00:30:27,280 --> 00:30:29,480 ENCEPHALOPATHY OR THIS MENTAL 838 00:30:29,480 --> 00:30:30,360 STATUS ABNORMALITIES. 839 00:30:30,360 --> 00:30:31,680 MOST OF THESE PEOPLE DEVELOPED 840 00:30:31,680 --> 00:30:33,080 THESE ACUTELY, WITHIN A COUPLE 841 00:30:33,080 --> 00:30:34,080 OF DAYS OF INITIAL COVID 842 00:30:34,080 --> 00:30:35,640 SYMPTOMS. 843 00:30:35,640 --> 00:30:38,920 AND PEOPLE THAT DID HAVE A NEW 844 00:30:38,920 --> 00:30:39,640 NEUROLOGICAL EVENT UNFORTUNATELY 845 00:30:39,640 --> 00:30:41,520 HAD A MUCH HIGHER RATE OF 846 00:30:41,520 --> 00:30:42,760 IN-HOSPITAL DEATH, WHICH WAS 847 00:30:42,760 --> 00:30:44,000 INCREASED BY 38% COMPARED TO 848 00:30:44,000 --> 00:30:47,840 THOSE WHO DID NOT. 849 00:30:47,840 --> 00:30:49,520 DURING THIS INITIAL 850 00:30:49,520 --> 00:30:50,960 HOSPITALIZATION, WE ALSO LOOKED 851 00:30:50,960 --> 00:30:53,440 AT SOME BLOOD MARKERS OF BRAIN 852 00:30:53,440 --> 00:30:54,520 INJURY. 853 00:30:54,520 --> 00:30:58,440 AND WE USED SINGLE MOLECULAR 854 00:30:58,440 --> 00:31:02,840 ARRAY TECHNOLOGY TO LOOK AT 855 00:31:02,840 --> 00:31:06,120 THESE MARKERS TAU, MARKERS OF 856 00:31:06,120 --> 00:31:07,560 NEURONAL INJURY. 857 00:31:07,560 --> 00:31:09,960 THIS PHOSPHORYLATED TAU IS MORE 858 00:31:09,960 --> 00:31:11,600 SPECIFIC TO ALZHEIMER'S-TYPE 859 00:31:11,600 --> 00:31:12,720 PATHOLOGY. 860 00:31:12,720 --> 00:31:15,560 GFAP IS A MARKER OF GLIAL CELLS 861 00:31:15,560 --> 00:31:22,560 OR ASTROCYTES AND AXONAL INJURY. 862 00:31:22,560 --> 00:31:25,200 PEOPLE THAT HAD TOXIC METABOLIC 863 00:31:25,200 --> 00:31:26,120 ENCEPHALOPATHY OR CHANGES IN 864 00:31:26,120 --> 00:31:27,600 THEIR MENTAL STATUS HAD 865 00:31:27,600 --> 00:31:28,360 SIGNIFICANTLY HIGHER LEVELS OF 866 00:31:28,360 --> 00:31:30,000 MANY OF THESE MARKERS, AS DID 867 00:31:30,000 --> 00:31:32,040 FOLKS WHO DIED IN HOSPITAL, AND 868 00:31:32,040 --> 00:31:33,800 THOSE WHO WERE ABLE TO GO HOME 869 00:31:33,800 --> 00:31:44,320 HAD SIGNIFICANTLY LOWER LEVELS. 870 00:31:46,000 --> 00:31:49,560 WE ALSO COMPARED LEVELS OF 871 00:31:49,560 --> 00:31:51,080 BIOMARKERS TO OUR ALZHEIMER'S 872 00:31:51,080 --> 00:31:54,160 DISEASE COHORT, WHO HAD DONATED 873 00:31:54,160 --> 00:31:57,120 BLOOD SAMPLES IN 2019. 874 00:31:57,120 --> 00:31:58,640 SO DEFINITELY WERE 875 00:31:58,640 --> 00:31:59,600 COVID-NEGATIVE, AND WHO HAD BEEN 876 00:31:59,600 --> 00:32:01,000 DIAGNOSED WITH EITHER MILD 877 00:32:01,000 --> 00:32:03,240 COGNITIVE IMPAIRMENT OR 878 00:32:03,240 --> 00:32:04,240 ALZHEIMER'S-TYPE DEMENTIA. 879 00:32:04,240 --> 00:32:05,240 FOR SOME OF THESE MARKERS, YOU 880 00:32:05,240 --> 00:32:07,280 CAN SEE THAT THE LEVELS WERE AS 881 00:32:07,280 --> 00:32:10,560 HIGH AS IF NOT SIGNIFICANTLY 882 00:32:10,560 --> 00:32:12,080 HIGHER THAN WHAT WAS OBSERVED IN 883 00:32:12,080 --> 00:32:12,960 ALZHEIMER'S-TYPE PATIENTS, 884 00:32:12,960 --> 00:32:14,080 INDICATING WE WERE LOOKING AT 885 00:32:14,080 --> 00:32:15,400 PEOPLE WITH A PRETTY SEVERE 886 00:32:15,400 --> 00:32:16,040 BRAIN INJURY. 887 00:32:16,040 --> 00:32:17,920 I ALSO WANT TO MENTION WHEN WE 888 00:32:17,920 --> 00:32:19,960 EVALUATED THE COVID PATIENTS, WE 889 00:32:19,960 --> 00:32:21,960 EXCLUDED PEOPLE WHO HAD PRIOR 890 00:32:21,960 --> 00:32:23,480 HISTORY OF DEMENTIA OR COGNITIVE 891 00:32:23,480 --> 00:32:24,600 DISORDER SO WE REALLY WANTED TO 892 00:32:24,600 --> 00:32:26,120 GET A SENSE OF ACUTE INJURY 893 00:32:26,120 --> 00:32:26,760 HAPPENING DURING THAT 894 00:32:26,760 --> 00:32:28,520 HOSPITALIZATION. 895 00:32:28,520 --> 00:32:30,960 SO WE FOLLOWED THESE FOLKS OUT 896 00:32:30,960 --> 00:32:32,560 AT SIX AND 12 MONTHS TO SEE WHAT 897 00:32:32,560 --> 00:32:33,640 THEIR OUTCOMES WERE. 898 00:32:33,640 --> 00:32:34,920 HERE'S A VARIETY OF SCALES THAT 899 00:32:34,920 --> 00:32:36,720 WE KIND OF MEASURED. 900 00:32:36,720 --> 00:32:38,920 MODIFIED RANKIN LOOKS AT DO YOU 901 00:32:38,920 --> 00:32:40,320 STILL HAVE SYMPTOMS, CAN YOU DO 902 00:32:40,320 --> 00:32:41,640 YOUR NORMAL ACTIVITY, CAN YOU 903 00:32:41,640 --> 00:32:43,320 WALK, ARE YOU BED-BOUND, ET 904 00:32:43,320 --> 00:32:44,040 CETERA. 905 00:32:44,040 --> 00:32:47,440 AND HIGHER SCORES ARE WORSE. 906 00:32:47,440 --> 00:32:48,960 BARTHEL IP DEX IS ACTIVITIES OF 907 00:32:48,960 --> 00:32:50,360 DAILY LIVING, CAN YOU GO TO THE 908 00:32:50,360 --> 00:32:52,920 BATHROOM BY YOURSELF, SHOWER, 909 00:32:52,920 --> 00:32:54,640 COMB YOUR HAIR, GET DRESSED, ET 910 00:32:54,640 --> 00:32:55,960 CETERA. 911 00:32:55,960 --> 00:32:59,920 TELEPHONE MOCA IS A COGNITIVE 912 00:32:59,920 --> 00:33:01,560 SCORE, PRETTY BASIC MEASURE OF 913 00:33:01,560 --> 00:33:02,520 COGNITION AND THEN WE ALSO 914 00:33:02,520 --> 00:33:04,520 LOOKED AT THESE SELF-REPORTED 915 00:33:04,520 --> 00:33:05,400 OUTCOMES HERE. 916 00:33:05,400 --> 00:33:07,360 I'LL JUST DRAW YOUR ATTENTION 917 00:33:07,360 --> 00:33:09,320 TO, OVERALL, THE FACT THAT 90% 918 00:33:09,320 --> 00:33:11,920 OF PEOPLE HAD AT LEAST ONE 919 00:33:11,920 --> 00:33:13,720 ABNORMAL METRIC AT SIX MONTHS, 920 00:33:13,720 --> 00:33:16,080 AND STILL 87% HAD AT LEAST ONE 921 00:33:16,080 --> 00:33:19,600 ABNORMAL METRIC AT 12 MONTHS IF 922 00:33:19,600 --> 00:33:27,600 YOU LOOK AT THE TELEPHONE MOCA 923 00:33:27,600 --> 00:33:29,200 SCORES, 41% TESTED ABNORMAL AT 924 00:33:29,200 --> 00:33:29,680 12 MONTHS. 925 00:33:29,680 --> 00:33:32,640 THESE ARE PEOPLE THAT HAD 926 00:33:32,640 --> 00:33:34,120 BASELINE AGAIN SHA OR COGNITIVE 927 00:33:34,120 --> 00:33:34,680 DIAGNOSES. 928 00:33:34,680 --> 00:33:35,880 THIS IS ADJUSTED FOR EDUCATIONAL 929 00:33:35,880 --> 00:33:36,800 IS IT TUS. 930 00:33:36,800 --> 00:33:38,640 SO SOMEWHAT PROFOUND COGNITIVE 931 00:33:38,640 --> 00:33:41,400 ISSUES EVEN OUT TO 12 MONTHS. 932 00:33:41,400 --> 00:33:43,800 THE GOOD NEWS, HOWEVER, WAS THAT 933 00:33:43,800 --> 00:33:47,000 BETWEEN 6 AND 12 MONTHS TESTING, 934 00:33:47,000 --> 00:33:48,400 WE DID SEE SIGNIFICANT 935 00:33:48,400 --> 00:33:50,080 IMPROVEMENTS IN MOCA SCORES AS 936 00:33:50,080 --> 00:33:51,320 WELL AS ANXIETY SCORES AND THERE 937 00:33:51,320 --> 00:33:52,960 WAS GENERALLY IMPROVEMENT IN A 938 00:33:52,960 --> 00:33:55,920 MAJORITY OF FOLKS FOR FATIGUE, 939 00:33:55,920 --> 00:33:58,000 DEPRESSION, SELF-REPORTED 940 00:33:58,000 --> 00:33:58,760 OUTCOMES. 941 00:33:58,760 --> 00:33:59,760 FUNCTIONAL STATUS AND ACTIVITIES 942 00:33:59,760 --> 00:34:01,160 OF DAILY LIVING ACTUALLY TENDED 943 00:34:01,160 --> 00:34:03,160 TO REMAIN STATIC AND PLATEAUED 944 00:34:03,160 --> 00:34:06,000 FOR MOST FOLKS, WHICH IS NOT 945 00:34:06,000 --> 00:34:07,640 UNEXPECTED SINCE MOST PEOPLE 946 00:34:07,640 --> 00:34:09,600 TYPICALLY MAKE THEIR MAXIMAL 947 00:34:09,600 --> 00:34:11,560 SPONTANEOUS RECOVERY WITHIN 3 TO 948 00:34:11,560 --> 00:34:12,800 6 MONTHS AFTER NEUROLOGICAL 949 00:34:12,800 --> 00:34:15,080 INJURY AND THEN PLATEAU. 950 00:34:15,080 --> 00:34:17,160 WHAT WE'RE INTERESTED IN NOW, I 951 00:34:17,160 --> 00:34:20,000 THINK, IS THESE RED BARS OF 952 00:34:20,000 --> 00:34:21,280 FOLKS WHO SEEM TO CONTINUE TO 953 00:34:21,280 --> 00:34:23,080 GET WORSE OVER TIME, AND SO WHAT 954 00:34:23,080 --> 00:34:25,600 IS DIFFERENT ABOUT THESE 955 00:34:25,600 --> 00:34:26,880 PATIENTS AND WHAT CAN WE DO TO 956 00:34:26,880 --> 00:34:30,920 INTERVENE IS, I THINK, AN 957 00:34:30,920 --> 00:34:32,120 IMPORTANT AREA OF FOCUS RIGHT 958 00:34:32,120 --> 00:34:32,280 NOW. 959 00:34:32,280 --> 00:34:33,480 WE ALSO LOOKED AT SUBJECTIVE 960 00:34:33,480 --> 00:34:34,200 SYMPTOMS. 961 00:34:34,200 --> 00:34:35,160 50% OF PEOPLE SAID THEY STILL 962 00:34:35,160 --> 00:34:38,520 HAD SYMPTOMS AT 12 MONTHS, AND 963 00:34:38,520 --> 00:34:41,560 THIS IS THE WHO CHECKLIST FOR 964 00:34:41,560 --> 00:34:44,720 SYMPTOMS SO THERE'S A LOT OF 965 00:34:44,720 --> 00:34:48,240 STUFF COVERED HERE, BRAIN FOG 966 00:34:48,240 --> 00:34:49,640 WAS REPORTED IN 20% OF PEOPLE. 967 00:34:49,640 --> 00:34:54,680 AND OVERALL, STILL 70%, 71% OF 968 00:34:54,680 --> 00:34:55,640 PEOPLE REPORTED MULTIPLE 969 00:34:55,640 --> 00:34:56,000 SYMPTOMS. 970 00:34:56,000 --> 00:34:59,920 MOST PEOPLE HAVE MORE THAN ONE. 971 00:34:59,920 --> 00:35:01,040 JUST TO REMIND FOLKS THAT 972 00:35:01,040 --> 00:35:03,720 SYMPTOMS ARE NOT THE SAME AS 973 00:35:03,720 --> 00:35:08,120 SIGNS OR STANDARDIZED TESTING. 974 00:35:08,120 --> 00:35:10,400 SO IF YOU WERE ESPECIALLY 975 00:35:10,400 --> 00:35:12,720 ATTENTIVE, 40% OF PEOPLE TESTED 976 00:35:12,720 --> 00:35:15,880 ABNORMAL ON A TELEPHONE MOCA BUT 977 00:35:15,880 --> 00:35:17,760 ONLY 20% SAID THEY HAD BRAIN 978 00:35:17,760 --> 00:35:18,200 FOG. 979 00:35:18,200 --> 00:35:19,800 SOME FOLKS MAY NOT RECOGNIZE 980 00:35:19,800 --> 00:35:21,160 THEY HAVE A DEFICIT, WHICH IS 981 00:35:21,160 --> 00:35:25,000 NOT COMMON AMONGST DEMENTIA 982 00:35:25,000 --> 00:35:25,960 PATIENTS OR PEOPLE THAT HAVE 983 00:35:25,960 --> 00:35:26,640 COGNITIVE ISSUES. 984 00:35:26,640 --> 00:35:28,040 I WILL SAY WE DID NOT HAVE 985 00:35:28,040 --> 00:35:29,880 BASELINE COGNITIVE TESTING PRIOR 986 00:35:29,880 --> 00:35:33,280 TO COVID, SO THAT'S A HUGE 987 00:35:33,280 --> 00:35:34,440 LIMITATION, BUT THERE PROBABLY 988 00:35:34,440 --> 00:35:35,280 IS A SUGGESTION OF THIS HERE. 989 00:35:35,280 --> 00:35:37,120 AND THIS IS IMPORTANT BECAUSE IN 990 00:35:37,120 --> 00:35:39,320 DESIGNING STUDIES, WE CAN'T JUST 991 00:35:39,320 --> 00:35:41,120 ENROLL PATIENTS THAT HAPPEN TO 992 00:35:41,120 --> 00:35:42,240 SAY THEY HAVE SYMPTOMS. 993 00:35:42,240 --> 00:35:44,800 THERE HAS TO BE OTHER CRITERIA 994 00:35:44,800 --> 00:35:46,400 FOR ENROLLMENT BECAUSE SOME 995 00:35:46,400 --> 00:35:49,680 PEOPLE MAY NOT RECOGNIZE 996 00:35:49,680 --> 00:35:50,680 DEFICITS AND STILL, THOSE ARE 997 00:35:50,680 --> 00:35:52,400 FOLKS THAT REALLY NEED TO BE 998 00:35:52,400 --> 00:35:55,480 INCLUDED IN STUDIES. 999 00:35:55,480 --> 00:35:56,600 THESE SYMPTOMS THAT PEOPLE HAD 1000 00:35:56,600 --> 00:35:59,440 WERE IMPORTANT. 1001 00:35:59,440 --> 00:36:01,600 45% OF PEOPLE SAID THEY COULDN'T 1002 00:36:01,600 --> 00:36:03,040 WORK TO THE DEGREE THEY HAD 1003 00:36:03,040 --> 00:36:04,720 PRIOR TO BEING HOSPITALIZED FOR 1004 00:36:04,720 --> 00:36:05,240 COVID. 1005 00:36:05,240 --> 00:36:07,680 THEY COULDN'T DO HOUSEHOLD 1006 00:36:07,680 --> 00:36:08,840 RESPONSIBILITIES OR LEISURE 1007 00:36:08,840 --> 00:36:09,920 ACTIVITIES, AND THIS WEEK, THERE 1008 00:36:09,920 --> 00:36:12,240 WAS A REPORT FROM THE BROOKINGS 1009 00:36:12,240 --> 00:36:13,400 INSTITUTE ESTIMATING THAT 1010 00:36:13,400 --> 00:36:16,960 16 MILLION AMERICANS HAVE LONG 1011 00:36:16,960 --> 00:36:19,640 COVID, AND THEN 2 TO 4 MILLION 1012 00:36:19,640 --> 00:36:21,400 OF THESE MAY BE UNABLE TO WORK 1013 00:36:21,400 --> 00:36:23,080 DUE TO COVID AND THIS WOULD 1014 00:36:23,080 --> 00:36:27,040 TRANSLATE INTO LOST WAGES OF 17, 1015 00:36:27,040 --> 00:36:28,560 SO THAT'S A SUBSTANTIAL IMPACT, 1016 00:36:28,560 --> 00:36:30,360 AND I THINK LONG COVID IS GOING 1017 00:36:30,360 --> 00:36:32,120 TO BE WITH US FOR A WHILE AS AN 1018 00:36:32,120 --> 00:36:34,840 AREA OF INTEREST FOR STUDY. 1019 00:36:34,840 --> 00:36:36,200 NOW I MENTIONED THAT 70% OF 1020 00:36:36,200 --> 00:36:37,760 PEOPLE AT LEAST IN OUR COHORT 1021 00:36:37,760 --> 00:36:39,960 HAD A LOT OF DIFFERENT SYMPTOMS. 1022 00:36:39,960 --> 00:36:41,280 IS EVERYBODY WITH LONG COVID THE 1023 00:36:41,280 --> 00:36:42,240 SAME? 1024 00:36:42,240 --> 00:36:42,720 NO. 1025 00:36:42,720 --> 00:36:46,600 AND I THINK WE DID A 1026 00:36:46,600 --> 00:36:49,720 HIERARCHICAL CLUSTER ANALYSIS ON 1027 00:36:49,720 --> 00:36:50,920 SUPERVISED STATISTICAL ANALYSIS 1028 00:36:50,920 --> 00:36:51,920 TRYING TO GROUP THESE FOLKS 1029 00:36:51,920 --> 00:36:52,920 TOGETHER TO SEE IF THERE'S 1030 00:36:52,920 --> 00:36:54,080 DIFFERENT TYPES OF PEOPLE WITH 1031 00:36:54,080 --> 00:36:55,080 LONG COVID. 1032 00:36:55,080 --> 00:36:57,240 WE CAME UP WITH THREE GROUPS. 1033 00:36:57,240 --> 00:36:59,360 ONE WITH FEW SYMPTOMS, ONE WITH 1034 00:36:59,360 --> 00:37:00,520 A HANDFUL OF SYMPTOMS AND THEN 1035 00:37:00,520 --> 00:37:03,600 ONE WITH A LOT OF SYMPTOMS. 1036 00:37:03,600 --> 00:37:04,680 THE FIRST GROUP, YOU KNOW, NOT 1037 00:37:04,680 --> 00:37:05,840 TOO MUCH GOING ON, THEY 1038 00:37:05,840 --> 00:37:08,680 COMPLAINED OF HEADACHE 1039 00:37:08,680 --> 00:37:09,400 PRIMARILY. 1040 00:37:09,400 --> 00:37:10,560 THE SECOND GROUP WAS A LITTLE 1041 00:37:10,560 --> 00:37:11,840 OVER HALF THE PEOPLE, THEY HAD 1042 00:37:11,840 --> 00:37:13,360 USUALLY ABOUT THREE SYMPTOMS, 1043 00:37:13,360 --> 00:37:14,360 SHORTNESS OF BREATH, HEADACHE 1044 00:37:14,360 --> 00:37:15,320 AND BRAIN FOG WERE THE MOST 1045 00:37:15,320 --> 00:37:15,640 COMMON. 1046 00:37:15,640 --> 00:37:16,840 AND THEN THERE WAS A MINORITY OF 1047 00:37:16,840 --> 00:37:18,080 PATIENTS THAT HAD MULTIPLE 1048 00:37:18,080 --> 00:37:18,720 SYMPTOMS. 1049 00:37:18,720 --> 00:37:21,240 MEDIAN OF 16 DIFFERENT SYMPTOMS. 1050 00:37:21,240 --> 00:37:23,320 THIS GROUP HAD PROMINENT ANXIETY 1051 00:37:23,320 --> 00:37:24,600 AND DEPRESSION, THEY HAD A 1052 00:37:24,600 --> 00:37:26,080 GREATER NUMBER OF LIFE 1053 00:37:26,080 --> 00:37:27,080 STRESSORS, WHICH IS RELATED 1054 00:37:27,080 --> 00:37:29,200 SOMEWHAT TO THE LAST TALK, AND 1055 00:37:29,200 --> 00:37:30,920 THEY WERE SICKER, THEY WERE MORE 1056 00:37:30,920 --> 00:37:32,400 OFTEN MECHANICALLY VENTILATED 1057 00:37:32,400 --> 00:37:34,160 DURING THEIR INDEX 1058 00:37:34,160 --> 00:37:35,160 HOSPITALIZATION. 1059 00:37:35,160 --> 00:37:37,080 WE ALSO LOOKED AT THERAPEUTIC 1060 00:37:37,080 --> 00:37:39,320 INTERVENTIONS THAT WERE APPLIED 1061 00:37:39,320 --> 00:37:41,400 TO THESE CLUSTERS, AND YOU KNOW, 1062 00:37:41,400 --> 00:37:43,880 NOT SURPRISINGLY, PATIENTS WITH 1063 00:37:43,880 --> 00:37:45,320 FEW SYMPTOMS WERE LESS LIKELY TO 1064 00:37:45,320 --> 00:37:47,440 RECEIVE INTERVENTIONS BUT A 1065 00:37:47,440 --> 00:37:49,360 SUBSTANTIAL PROPORTION DID 1066 00:37:49,360 --> 00:37:50,560 IMPROVE WITH WHATEVER THEY 1067 00:37:50,560 --> 00:37:50,840 RECEIVED. 1068 00:37:50,840 --> 00:37:52,760 IN THE MIDDLE GROUP, PHYSICAL 1069 00:37:52,760 --> 00:37:54,080 AND OCCUPATIONAL THERAPY WERE 1070 00:37:54,080 --> 00:37:55,280 COMMON AND A LOT OF PEOPLE 1071 00:37:55,280 --> 00:37:55,680 IMPROVED. 1072 00:37:55,680 --> 00:37:57,080 AND IN THIS LAST GROUP, WHICH IS 1073 00:37:57,080 --> 00:37:59,480 THE SICKEST GROUP, NOT JUST BY 1074 00:37:59,480 --> 00:38:02,120 SYMPTOMS BUT THEY ALSO HAD WORSE 1075 00:38:02,120 --> 00:38:03,080 FUNCTIONAL MODIFIED RANKIN 1076 00:38:03,080 --> 00:38:05,920 SCORES AND THEN WORSE REPORTED 1077 00:38:05,920 --> 00:38:07,560 METRICS FOR ANXIETY, DEPRESSION, 1078 00:38:07,560 --> 00:38:09,640 FATIGUE AND SLEEP. 1079 00:38:09,640 --> 00:38:10,960 THESE FOLKS WERE MORE LIKELY TO 1080 00:38:10,960 --> 00:38:12,920 RECEIVE SOME SORT OF PSYCHIATRIC 1081 00:38:12,920 --> 00:38:14,760 TREATMENT, WHETHER IT WAS TALK 1082 00:38:14,760 --> 00:38:18,640 THERAPY OR MEDICAL INTERVENTION, 1083 00:38:18,640 --> 00:38:21,560 AND FORTUNATELY 100% REPORTED 1084 00:38:21,560 --> 00:38:22,480 SOME DEGREE OF IMPROVEMENT. 1085 00:38:22,480 --> 00:38:24,520 IT'S A SMALL N, ONLY 2200 1086 00:38:24,520 --> 00:38:26,720 PEOPLE, BUT I WANT TO BRING THIS 1087 00:38:26,720 --> 00:38:28,120 TO LIGHT JUST BECAUSE I THINK 1088 00:38:28,120 --> 00:38:30,520 IT'S IMPORTANT TO TAKE A 1089 00:38:30,520 --> 00:38:32,840 HOLISTIC APPROACH IN RECOGNIZING 1090 00:38:32,840 --> 00:38:34,680 NOT EVERY COVID PATIENT IS THE 1091 00:38:34,680 --> 00:38:38,000 SAME, AND THAT NEUROPSYCHIATRIC 1092 00:38:38,000 --> 00:38:39,600 INTERVENTIONS SHOULD BE 1093 00:38:39,600 --> 00:38:40,800 CONSIDERED AND APPLIED AS 1094 00:38:40,800 --> 00:38:42,240 APPROPRIATE IN SORT OF A 1095 00:38:42,240 --> 00:38:43,680 HOLISTIC APPROACH FOR THESE 1096 00:38:43,680 --> 00:38:46,640 FOLKS. 1097 00:38:46,640 --> 00:38:48,480 WE ALSO LOOKED AT PREDICTORS OF 1098 00:38:48,480 --> 00:38:49,680 OBJECTIVE AND SUBJECTIVE 1099 00:38:49,680 --> 00:38:51,400 OUTCOMES, AND REALLY THERE WERE 1100 00:38:51,400 --> 00:38:53,000 FIVE MAIN ONES THAT CAME UP. 1101 00:38:53,000 --> 00:38:54,320 THESE HAVE BEEN SORT OF SEEN IN 1102 00:38:54,320 --> 00:38:56,440 DIFFERENT COHORTS AS WELL AS 1103 00:38:56,440 --> 00:39:00,600 OURS, NOT SURPRISINGLY, OLDER 1104 00:39:00,600 --> 00:39:02,680 FOLKS HAD WORSE FUNCTIONAL 1105 00:39:02,680 --> 00:39:04,200 OUTCOMES, ACTIVITIES OF DAILY 1106 00:39:04,200 --> 00:39:05,320 LIVING, WORSE COGNITIVE STATUS 1107 00:39:05,320 --> 00:39:07,160 AND HIGHER RATES OF DEPRESSION, 1108 00:39:07,160 --> 00:39:15,160 SUBJECTIVE DEPRESSION. 1109 00:39:15,160 --> 00:39:19,080 BASELINE DISABILITY WAS -- IF 1110 00:39:19,080 --> 00:39:20,960 YOU'RE DISABLED AT BASELINE YOU 1111 00:39:20,960 --> 00:39:22,160 WERE EVEN MORE DISABLED 1112 00:39:22,160 --> 00:39:23,360 AFTERWARDS, WHICH IS KIND OF 1113 00:39:23,360 --> 00:39:25,240 INTUITIVE, AND THEN LIFE VERY 1114 00:39:25,240 --> 00:39:26,760 STRESSORS, WHAT WE LOOKED AT 1115 00:39:26,760 --> 00:39:30,160 WERE 13 DIFFERENT STRESSORS 1116 00:39:30,160 --> 00:39:32,120 SIMILAR TO WHAT DR. MARQUINE WAS 1117 00:39:32,120 --> 00:39:32,480 DISCUSSING. 1118 00:39:32,480 --> 00:39:33,800 WE LOOKED AT FINANCIAL 1119 00:39:33,800 --> 00:39:35,760 INSECURITY, FOOD INSECURITY, 1120 00:39:35,760 --> 00:39:40,160 SOCIAL ISOLATION, RELATIONSHIP 1121 00:39:40,160 --> 00:39:43,320 DIFFICULTIES AT HOME, EDUCATION 1122 00:39:43,320 --> 00:39:44,000 DISRUPTION, DOMESTIC VIOLENCE, 1123 00:39:44,000 --> 00:39:45,720 ET CETERA. 1124 00:39:45,720 --> 00:39:48,560 AND THESE STRESSORS ACTUALLY HAD 1125 00:39:48,560 --> 00:39:50,520 HIGHER ODDS RATIOS OR ADJUSTED 1126 00:39:50,520 --> 00:39:52,480 ODDS RATIOS FOR PREDICTING WORSE 1127 00:39:52,480 --> 00:39:53,520 OUTCOMES THAN ALMOST ANY OF 1128 00:39:53,520 --> 00:39:55,280 THESE OTHER PREDICTORS I'M 1129 00:39:55,280 --> 00:39:55,840 SHOWING YOU HERE. 1130 00:39:55,840 --> 00:39:58,320 THIS WAS ACROSS A SPECTRUM OF 1131 00:39:58,320 --> 00:39:59,520 DIFFERENT OUTCOMES, INCLUDING 1132 00:39:59,520 --> 00:40:00,600 SUBJECTIVE SYMPTOMS. 1133 00:40:00,600 --> 00:40:02,800 COVID SEVERITY AS IN MANY 1134 00:40:02,800 --> 00:40:04,480 COHORTS ALSO AFFECTS 1135 00:40:04,480 --> 00:40:05,760 NEURODEVELOPMENT OF POST-ACUTE 1136 00:40:05,760 --> 00:40:07,520 SYMPTOMS AND ACTIVITIES OF DAILY 1137 00:40:07,520 --> 00:40:07,840 LIVING. 1138 00:40:07,840 --> 00:40:09,360 OUR COHORT, SOME MIGHT CONSIDER 1139 00:40:09,360 --> 00:40:11,040 ALL OF THEM TO BE SEVERE BECAUSE 1140 00:40:11,040 --> 00:40:12,480 THEY'RE ALL HOSPITALIZED, BUT 1141 00:40:12,480 --> 00:40:14,840 WHEN WE SAY SEVERITY HERE, WE'RE 1142 00:40:14,840 --> 00:40:15,640 TALKING ABOUT REQUIRING 1143 00:40:15,640 --> 00:40:17,960 MECHANICAL VENTILATION. 1144 00:40:17,960 --> 00:40:19,720 BUT CERTAINLY COVID SEVERITY IS 1145 00:40:19,720 --> 00:40:23,960 A DRIVER OF POST-ACUTE SEQUELAE. 1146 00:40:23,960 --> 00:40:25,640 LAST I'M JUST GOING TO SHOW YOU 1147 00:40:25,640 --> 00:40:27,200 THIS, THIS IS A HEAT MAP. 1148 00:40:27,200 --> 00:40:30,480 DON'T LOOK AT THE NUMBER, NT 1149 00:40:30,480 --> 00:40:32,880 THIS IS LOOKING AT THOSE SAME 1150 00:40:32,880 --> 00:40:34,480 BIOMARKERS I SHOWED YOU EARLIER. 1151 00:40:34,480 --> 00:40:35,840 GREEN MEANS THERE'S STRONG OR 1152 00:40:35,840 --> 00:40:36,520 SIGNIFICANT ASSOCIATION. 1153 00:40:36,520 --> 00:40:37,920 YOU CAN SEE SOME OF THESE 1154 00:40:37,920 --> 00:40:39,240 BIOMARKERS DO LIGHT UP IN TERMS 1155 00:40:39,240 --> 00:40:40,920 OF MATCHING UP WITH OUTCOMES AT 1156 00:40:40,920 --> 00:40:43,080 6 MONTHS AND 12 MONTHS, AND THIS 1157 00:40:43,080 --> 00:40:44,960 IS A VERY SMALL SAMPLE SIZE. 1158 00:40:44,960 --> 00:40:46,160 SO YOU HAVE TO TAKE THIS WITH A 1159 00:40:46,160 --> 00:40:47,480 LITTLE BIT OF A GRAIN OF SALT. 1160 00:40:47,480 --> 00:40:50,800 BUT WE DID FIND THAT NFL WAS 1161 00:40:50,800 --> 00:40:52,080 ASSOCIATED WITH SIGNIFICANTLY 1162 00:40:52,080 --> 00:40:53,520 HIGHER RISK OF DEATH OR SEVERE 1163 00:40:53,520 --> 00:40:55,240 DISABILITY AFTER ADJUSTING FOR 1164 00:40:55,240 --> 00:40:55,920 OTHER FACTORS. 1165 00:40:55,920 --> 00:40:56,840 THAT'S KIND OF INTERESTING 1166 00:40:56,840 --> 00:40:59,560 BECAUSE WE'RE ALL IN SEARCH OF A 1167 00:40:59,560 --> 00:41:01,720 BRAIN TROPONIN AND THERE'S OTHER 1168 00:41:01,720 --> 00:41:03,080 STUDIES ALSO SUGGESTING THAT NFL 1169 00:41:03,080 --> 00:41:05,680 MIGHT BE A GOOD BIO MARKER. 1170 00:41:05,680 --> 00:41:08,640 AND LASTLY, I'M JUST GOING TO 1171 00:41:08,640 --> 00:41:10,080 SAY WE HAVE A FEW STUDIES GOING 1172 00:41:10,080 --> 00:41:10,400 ON NOW. 1173 00:41:10,400 --> 00:41:13,720 WE HAVE AN R01 THAT I AM 1174 00:41:13,720 --> 00:41:16,640 PARTICIPATING IN AS A P.I. WITH 1175 00:41:16,640 --> 00:41:19,520 PEOPLE AT OUR ADRC, 1176 00:41:19,520 --> 00:41:21,040 DR. WISNIEWSKI AND OUR 1177 00:41:21,040 --> 00:41:22,440 NEURORADIOLOGY GROUP WITH 1178 00:41:22,440 --> 00:41:22,920 DR. GI. 1179 00:41:22,920 --> 00:41:24,640 WE'RE PARTICULARLY LOOKING AT 1180 00:41:24,640 --> 00:41:26,520 KIND OF APPLYING THE VIRAL 1181 00:41:26,520 --> 00:41:28,360 THEORY OF ALZHEIMER'S TO POST 1182 00:41:28,360 --> 00:41:32,440 COVID AND LOOKING AT HOW 1183 00:41:32,440 --> 00:41:34,400 HYPOXIA, LOW OXYGEN LEVELS, 1184 00:41:34,400 --> 00:41:35,280 INFLAMMATION, CAN CONTRIBUTE TO 1185 00:41:35,280 --> 00:41:38,120 A CASCADE OF INJURY THAT COULD 1186 00:41:38,120 --> 00:41:41,200 LEAD TO BUILDUP OF AMYLOID BETA 1187 00:41:41,200 --> 00:41:42,400 AND NEUROFIBROID TANGLES IN THE 1188 00:41:42,400 --> 00:41:42,600 BRAIN. 1189 00:41:42,600 --> 00:41:44,280 >> DR. FRONTERA, I THINK WE'RE 1190 00:41:44,280 --> 00:41:45,520 GOING TO NEED TO MOVE TO YOUR 1191 00:41:45,520 --> 00:41:46,080 LAST SLIDE. 1192 00:41:46,080 --> 00:41:46,680 >> OKAY. 1193 00:41:46,680 --> 00:41:51,080 SURE. 1194 00:41:51,080 --> 00:41:52,160 I'LL JUST SKIP QUICKLY THROUGH 1195 00:41:52,160 --> 00:41:53,560 THIS, BUT IF ANYONE IS 1196 00:41:53,560 --> 00:41:56,400 INTERESTED, WE DO HAVE AN 1197 00:41:56,400 --> 00:41:57,760 NINDS-FUNDED DATA BIOBANK WHERE 1198 00:41:57,760 --> 00:42:00,160 WE'RE LOOKING AT ACUTE AND 1199 00:42:00,160 --> 00:42:02,640 POST-ACUTE NEUROLOGICAL 1200 00:42:02,640 --> 00:42:03,560 OUTCOMES, AND THEN OF COURSE 1201 00:42:03,560 --> 00:42:04,440 THERE'S THE RECOVER PROJECT, 1202 00:42:04,440 --> 00:42:07,640 WHICH IS A LARGE $1.2 BILLION 1203 00:42:07,640 --> 00:42:10,040 PROJECT LOOKING AT POST COVID 1204 00:42:10,040 --> 00:42:13,520 ACROSS THE LIFE SPECTRUM. 1205 00:42:13,520 --> 00:42:16,920 AND SO JUST TO WRAP UP, YOU 1206 00:42:16,920 --> 00:42:19,000 KNOW, THERE'S A CONCERN ABOUT 1207 00:42:19,000 --> 00:42:20,120 NEURODEGENERATION AND ACUTE 1208 00:42:20,120 --> 00:42:21,200 BIOMARKERS IN THE ACUTE PHASE, 1209 00:42:21,200 --> 00:42:23,160 AND WE STILL SEE A LOT OF 1210 00:42:23,160 --> 00:42:25,000 DISABILITY EVEN OUT TO 6 AND 12 1211 00:42:25,000 --> 00:42:27,360 MONTHS IN THESE FOLKS. 1212 00:42:27,360 --> 00:42:28,600 THOUGH THERE IS SOME IMPROVEMENT 1213 00:42:28,600 --> 00:42:31,640 IN COGNITIVE SCORES OVER TIME. 1214 00:42:31,640 --> 00:42:32,960 LIFE STRESSORS ARE REALLY 1215 00:42:32,960 --> 00:42:34,040 IMPORTANT, AS ARE SOME OF THE 1216 00:42:34,040 --> 00:42:35,600 OTHER PREDICTORS THAT WE EXPECT, 1217 00:42:35,600 --> 00:42:37,440 BUT THEY SHOULD BE CONSIDERED 1218 00:42:37,440 --> 00:42:38,320 AND ADDRESSED. 1219 00:42:38,320 --> 00:42:39,920 AND THERE'S SOME ONGOING STUDIES 1220 00:42:39,920 --> 00:42:42,120 THAT ARE SUPPORTED BY THE NIH 1221 00:42:42,120 --> 00:42:44,360 THAT HOPEFULLY WILL HELP US 1222 00:42:44,360 --> 00:42:46,560 DISENTANGLE WHAT'S HAPPENING 1223 00:42:46,560 --> 00:42:48,080 WITH POST COVID. 1224 00:42:48,080 --> 00:42:49,720 I'D LIKE TO THANK THE HUGE TEAM 1225 00:42:49,720 --> 00:42:51,600 THAT SUPPORTED THIS WORK, AND 1226 00:42:51,600 --> 00:42:59,720 THANK EVERYBODY FOR THEIR TIME. 1227 00:42:59,720 --> 00:43:03,520 >> OKAY. 1228 00:43:03,520 --> 00:43:07,600 THANK YOU, DR. FRONTERA. 1229 00:43:07,600 --> 00:43:09,440 SO DO I HAVE CONTROL OF THE 1230 00:43:09,440 --> 00:43:18,520 SCREEN NOW? 1231 00:43:18,520 --> 00:43:20,280 MY NAME IS DR. JAMES NOBLE, 1232 00:43:20,280 --> 00:43:21,920 NEUROLOGIST AT COLUMBIA 1233 00:43:21,920 --> 00:43:22,920 UNIVERSITY IRVINGTON MEDICAL 1234 00:43:22,920 --> 00:43:23,360 CENTER. 1235 00:43:23,360 --> 00:43:25,200 I'M THE CLINICAL LEADER OF OUR 1236 00:43:25,200 --> 00:43:26,040 ALZHEIMER'S DISEASE RESEARCH 1237 00:43:26,040 --> 00:43:27,400 CENTER AND FOCUS PRIMARILY ON 1238 00:43:27,400 --> 00:43:28,840 COGNITIVE DISORDERS OF AGING. 1239 00:43:28,840 --> 00:43:30,600 I'M GOING TO BE PRESENTING TODAY 1240 00:43:30,600 --> 00:43:33,160 TO YOU SOME OF THE THINGS THAT 1241 00:43:33,160 --> 00:43:34,320 ARE REALLY SERVING IN COMPLEMENT 1242 00:43:34,320 --> 00:43:35,640 TO THE PRIOR SPEAKERS, AND 1243 00:43:35,640 --> 00:43:37,000 TRYING TO SHARE WITH YOU WHAT WE 1244 00:43:37,000 --> 00:43:39,520 LEARNED AS WE WERE REALLY IN THE 1245 00:43:39,520 --> 00:43:43,880 MIDST OF THE COVID FIRST WAVE, 1246 00:43:43,880 --> 00:43:45,320 AND TRANSLATING THOSE FINDINGS 1247 00:43:45,320 --> 00:43:46,640 INTO NOW WHAT WE ARE REALLY 1248 00:43:46,640 --> 00:43:47,840 INTERESTED IN, WHICH ARE 1249 00:43:47,840 --> 00:43:48,680 LONGITUDINAL STUDIES OF 1250 00:43:48,680 --> 00:43:49,280 COGNITIVE AGING. 1251 00:43:49,280 --> 00:43:52,240 WHAT DOES IT MEAN TO HAVE HAD 1252 00:43:52,240 --> 00:43:53,560 COVID BOTH IN THE INITIAL WAVES 1253 00:43:53,560 --> 00:43:55,400 AND SUBSEQUENT TIMES. 1254 00:43:55,400 --> 00:43:57,040 SO I WANT TO THANK THE 1255 00:43:57,040 --> 00:43:58,920 ORGANIZERS AND THE SUPPORT I'VE 1256 00:43:58,920 --> 00:44:00,240 RECEIVED PREVIOUSLY. 1257 00:44:00,240 --> 00:44:02,240 HERE ARE MY DISCLOSURES, 1258 00:44:02,240 --> 00:44:04,080 PRIMARILY RELATED ONES ARE THE 1259 00:44:04,080 --> 00:44:05,200 NIH GRANT SUPPORT THAT I RECEIVE 1260 00:44:05,200 --> 00:44:06,600 WHICH IN PART HAS FUNDED SOME OF 1261 00:44:06,600 --> 00:44:07,760 THIS WORK. 1262 00:44:07,760 --> 00:44:08,960 TODAY WE'RE GOING TO BE 1263 00:44:08,960 --> 00:44:09,800 REVIEWING AS I SAID THE 1264 00:44:09,800 --> 00:44:11,240 EXPERIENCES WE HAD AT OUR 1265 00:44:11,240 --> 00:44:13,240 CENTER, THE EPIDEMIOLOGY 1266 00:44:13,240 --> 00:44:14,000 DEMENTIA RELATED TO COVID 1267 00:44:14,000 --> 00:44:15,080 SYMPTOMS AND MORTALITY THAT WE 1268 00:44:15,080 --> 00:44:16,880 FOUND AT OUR CENTER DURING THE 1269 00:44:16,880 --> 00:44:18,320 FIRST NEW YORK CITY WAVE, AND 1270 00:44:18,320 --> 00:44:20,480 HOW WE'VE THOUGHT ABOUT THAT AS 1271 00:44:20,480 --> 00:44:22,360 EVOLVING CONCEPTS AND 1272 00:44:22,360 --> 00:44:24,200 COMPLICATIONS HAVE EMERGED, 1273 00:44:24,200 --> 00:44:25,560 INCLUDING LONG COVID BUT ALSO 1274 00:44:25,560 --> 00:44:26,640 BALANCING THAT AGAINST NEW 1275 00:44:26,640 --> 00:44:27,720 TREATMENTS AND VACCINATION 1276 00:44:27,720 --> 00:44:29,320 STRATEGIES THAT HAVE EMERGED 1277 00:44:29,320 --> 00:44:30,080 SIMULTANEOUSLY. 1278 00:44:30,080 --> 00:44:31,920 AND ALSO HOW DO WE PUT ALL OF 1279 00:44:31,920 --> 00:44:33,240 THAT TOGETHER AND BEGIN TO 1280 00:44:33,240 --> 00:44:34,800 LEVERAGE WHAT EXISTING STUDIES 1281 00:44:34,800 --> 00:44:36,560 WE HAVE TO BETTER UNDERSTAND THE 1282 00:44:36,560 --> 00:44:38,440 IMPACTS OF COVID ON AGING 1283 00:44:38,440 --> 00:44:39,080 POPULATIONS, ESPECIALLY THOSE 1284 00:44:39,080 --> 00:44:41,960 WHO ARE AT RISK OF OR WHO 1285 00:44:41,960 --> 00:44:43,600 ALREADY HAVE DEMENTIA AND OTHER 1286 00:44:43,600 --> 00:44:44,600 COGNITIVE DISORDERS. 1287 00:44:44,600 --> 00:44:46,360 SO JUST TO REFLECT ON WHERE WE 1288 00:44:46,360 --> 00:44:47,560 GOT STARTED, IT'S HARD TO 1289 00:44:47,560 --> 00:44:48,840 BELIEVE THAT JUST 2 1/2 YEARS 1290 00:44:48,840 --> 00:44:50,320 AGO, THE WORLD WAS SO DIFFERENT 1291 00:44:50,320 --> 00:44:52,440 BUT IT WAS, AND AT THE TIME, 1292 00:44:52,440 --> 00:44:54,680 JUST BEFORE THE PANDEMIC HIT, WE 1293 00:44:54,680 --> 00:44:56,200 IN OUR PRACTICE HAD 13 1294 00:44:56,200 --> 00:44:57,880 CLINICIANS INCLUDING EIGHT 1295 00:44:57,880 --> 00:44:59,120 FACULTY, THREE FELLOWS AND A 1296 00:44:59,120 --> 00:45:02,640 NURSE PRACTITIONER, AND THAT S 1297 00:45:02,640 --> 00:45:03,840 LARGELY BEEN OUR SETUP EVER 1298 00:45:03,840 --> 00:45:05,400 SINCE AND OUR PRACTICE IS VERY 1299 00:45:05,400 --> 00:45:06,720 LARGE, WE SEE SOMEWHERE BETWEEN 1300 00:45:06,720 --> 00:45:07,960 800 AND 1,000 NEW INDIVIDUALS 1301 00:45:07,960 --> 00:45:09,560 WITH COGNITIVE CONCERNS AND TWO 1302 00:45:09,560 --> 00:45:11,560 TO 3,000 FOLLOW-UPS ANNUALLY. 1303 00:45:11,560 --> 00:45:12,960 WE SERVE PRIMARILY THE RESIDENTS 1304 00:45:12,960 --> 00:45:14,760 OF NORTHERN MANHATTAN, INCLUDING 1305 00:45:14,760 --> 00:45:16,040 WASHINGTON HEIGHTS AND THE 1306 00:45:16,040 --> 00:45:16,920 SOUTHWEST BRONX. 1307 00:45:16,920 --> 00:45:19,440 AND WE HAVE ALSO A LARGE 1308 00:45:19,440 --> 00:45:20,240 REFERRAL BASIS FROM THE 1309 00:45:20,240 --> 00:45:20,600 TRI-STATE AREA. 1310 00:45:20,600 --> 00:45:22,240 WE WERE ENTIRELY IN-PERSON 1311 00:45:22,240 --> 00:45:23,760 THROUGH FEBRUARY 2020. 1312 00:45:23,760 --> 00:45:25,520 WE ALSO HAVE AT OUR CENTER THE 1313 00:45:25,520 --> 00:45:27,240 BENEFIT OF A LARGE RESEARCH 1314 00:45:27,240 --> 00:45:29,360 PORTFOLIO TRYING TO HELP US 1315 00:45:29,360 --> 00:45:30,280 UNDERSTAND NORMAL COGNITIVE 1316 00:45:30,280 --> 00:45:31,680 AGING BOTH IN COMMUNITY COHORTS 1317 00:45:31,680 --> 00:45:34,400 AS WELL AS THOSE PERSONS WHO ARE 1318 00:45:34,400 --> 00:45:35,720 AFFECTED BY DEMENTIA AND 1319 00:45:35,720 --> 00:45:36,720 ENROLLED IN LARGE TRIALS. 1320 00:45:36,720 --> 00:45:42,960 AND WE ARE ALSO SUPPORTED BY A 1321 00:45:42,960 --> 00:45:45,840 PROGRAM WHICH IS RELATIVELY 1322 00:45:45,840 --> 00:45:47,360 AGNOSTIC TO INSURANCE STATUS, 1323 00:45:47,360 --> 00:45:50,400 NOT JUST PATIENTS WITH YOU O 1324 00:45:50,400 --> 00:45:51,800 EDUCATE OTHER CAREGIVERS AND 1325 00:45:51,800 --> 00:45:53,280 CLINICIANS IN THE COMMUNITY. 1326 00:45:53,280 --> 00:45:55,040 AND JUST TO REFLECT ON THE 1327 00:45:55,040 --> 00:45:56,040 SPECIFIC EXPERIENCE OF NEW YORK, 1328 00:45:56,040 --> 00:45:58,600 HERE WE ARE WITH THE WAVES AS 1329 00:45:58,600 --> 00:45:59,800 HAVE BEEN SEEN MANY TIMES. 1330 00:45:59,800 --> 00:46:02,400 THESE ARE FROM THE JOHNS HOPKINS 1331 00:46:02,400 --> 00:46:04,280 DASHBOARDS THAT ARE CURRENTLY 1332 00:46:04,280 --> 00:46:05,480 AVAILABLE AND WE'RE PROBABLY ALL 1333 00:46:05,480 --> 00:46:07,160 FAMILIAR WITH, BUT JUST TO KIND 1334 00:46:07,160 --> 00:46:09,120 OF REFLECT ON WHAT NEW YORK'S 1335 00:46:09,120 --> 00:46:10,560 EXPERIENCE WAS, WE WERE REALLY 1336 00:46:10,560 --> 00:46:12,640 IN THE CENTER OF A LOT OF 1337 00:46:12,640 --> 00:46:14,600 EMERGING AND NEW CONCERNING 1338 00:46:14,600 --> 00:46:16,080 DATA, WE'RE VERY CONCERNED ABOUT 1339 00:46:16,080 --> 00:46:17,560 WHAT OUR PATIENTS' WELL-BEING 1340 00:46:17,560 --> 00:46:20,160 WAS, AND THIS REALLY BEGAN IN 1341 00:46:20,160 --> 00:46:20,440 EARLY MARCH. 1342 00:46:20,440 --> 00:46:22,200 AND THAT ALSO, I WANT TO PUT IN 1343 00:46:22,200 --> 00:46:23,760 CONTEXT TO THE REMAINDER OF THE 1344 00:46:23,760 --> 00:46:24,760 UNITED STATES, WHICH HAS REALLY 1345 00:46:24,760 --> 00:46:26,040 HELPED US THINK ABOUT NATIONALLY 1346 00:46:26,040 --> 00:46:27,320 WHEN WE THINK ABOUT ALZHEIMER'S 1347 00:46:27,320 --> 00:46:28,400 RESEARCH STRATEGIES ON A 1348 00:46:28,400 --> 00:46:29,840 NATIONAL LEVEL, THAT WHAT FITS 1349 00:46:29,840 --> 00:46:31,040 FOR NEW YORK DOES NOT FIT FOR 1350 00:46:31,040 --> 00:46:31,400 EVERYBODY ELSE. 1351 00:46:31,400 --> 00:46:33,560 THE TIMING OF WHAT WE 1352 00:46:33,560 --> 00:46:35,560 EXPERIENCED WAS VERY DIFFERENT 1353 00:46:35,560 --> 00:46:37,000 THAN WHAT THE REMAINDER OF THE 1354 00:46:37,000 --> 00:46:38,000 COUNTRY EXPERIENCED, AND OFTEN 1355 00:46:38,000 --> 00:46:39,560 WE WERE KIND OF THE LEADING EDGE 1356 00:46:39,560 --> 00:46:40,080 OF THOSE THINGS. 1357 00:46:40,080 --> 00:46:44,720 BACK ON MARCH 2ND, 2020, WE HAD 1358 00:46:44,720 --> 00:46:45,920 THE FIRST CASE THAT WAS 1359 00:46:45,920 --> 00:46:48,840 HOPTDIZED 1360 00:46:48,840 --> 00:46:50,160 HOSPITALIZED AT COLUMBIA, THE 1361 00:46:50,160 --> 00:46:51,560 FIRST CASE DIAGNOSED A DAY OR 1362 00:46:51,560 --> 00:46:53,160 TWO BEFORE AT ANOTHER CENTER BUT 1363 00:46:53,160 --> 00:46:55,160 WE HAD THE FIRST HOSPITALIZED 1364 00:46:55,160 --> 00:46:57,000 PATIENT HERE, WITHIN TWO WEEKS, 1365 00:46:57,000 --> 00:46:57,800 BASICALLY EVERYTHING SHUT DOWN. 1366 00:46:57,800 --> 00:46:59,200 ALL OF OUR RESEARCH REALLY CAME 1367 00:46:59,200 --> 00:46:59,920 TO A HALT. 1368 00:46:59,920 --> 00:47:01,760 THE NEXT STEP WE HAD ABOUT THREE 1369 00:47:01,760 --> 00:47:03,480 MONTHS LATER SOME RESEARCH 1370 00:47:03,480 --> 00:47:04,640 RESUMED, PRIMARILY REMOTE BUT 1371 00:47:04,640 --> 00:47:06,520 SOME INPATIENT WORK, IN-PERSON 1372 00:47:06,520 --> 00:47:06,960 WORK. 1373 00:47:06,960 --> 00:47:08,400 SCHOOLS RE-OPENED SIX MONTHS 1374 00:47:08,400 --> 00:47:10,240 LATER ON A DELAYED TIMELINE, AND 1375 00:47:10,240 --> 00:47:14,280 THEN WE BEGAN TO HAVE THE 1376 00:47:14,280 --> 00:47:15,840 VACCINATIONS AVAILABLE REALLY 1377 00:47:15,840 --> 00:47:18,800 JUST BEFORE MID DECEMBER IN 1378 00:47:18,800 --> 00:47:21,080 2020. 1379 00:47:21,080 --> 00:47:22,480 AGAIN THE TIMELINE IN THE 1380 00:47:22,480 --> 00:47:23,440 REMAINDER OF THE COUNTRY WAS 1381 00:47:23,440 --> 00:47:24,080 QUITE DIFFERENT. 1382 00:47:24,080 --> 00:47:25,520 THERE WERE LAGS WITH FIRST WAVES 1383 00:47:25,520 --> 00:47:26,480 AND SECOND WAVES LOOKING VERY 1384 00:47:26,480 --> 00:47:27,080 DIFFERENT THAN WHAT WE 1385 00:47:27,080 --> 00:47:27,840 EXPERIENCED IN NEW YORK, AND 1386 00:47:27,840 --> 00:47:29,160 JUST TO GIVE YOU A SENSE, THESE 1387 00:47:29,160 --> 00:47:30,120 ARE DIFFERENT SCALES HERE, BUT 1388 00:47:30,120 --> 00:47:32,800 THE RELATIVE WAVES ARE IMPORTANT 1389 00:47:32,800 --> 00:47:33,640 TO UNDERSTAND THAT NOT 1390 00:47:33,640 --> 00:47:35,640 EVERYTHING LINED UP. 1391 00:47:35,640 --> 00:47:36,600 AS HAS BEEN SHARED FROM SOME OF 1392 00:47:36,600 --> 00:47:37,720 THE OTHER INVESTIGATORS HERE 1393 00:47:37,720 --> 00:47:39,080 TODAY, WE REALLY HAD TWO KIND OF 1394 00:47:39,080 --> 00:47:41,320 CALLS THAT WE RECEIVED IN OUR 1395 00:47:41,320 --> 00:47:43,520 PRACTICE, WHICH HAVE EVOLVED 1396 00:47:43,520 --> 00:47:46,600 INTO KIND OF OUR OWN RESEARCH 1397 00:47:46,600 --> 00:47:47,200 EXPERIENCE AND THE INTERESTS 1398 00:47:47,200 --> 00:47:47,920 THAT WE HAD. 1399 00:47:47,920 --> 00:47:50,120 ONE WAS WE WERE SEEING DELIRIUM 1400 00:47:50,120 --> 00:47:51,600 IN PERSON WITH POSSIBLE COVID 1401 00:47:51,600 --> 00:47:52,240 SYMPTOMS AT A TIME WHEN IT WAS 1402 00:47:52,240 --> 00:47:53,440 VERY DIFFICULT TO GET A TEST AND 1403 00:47:53,440 --> 00:47:54,480 FAMILIES WERE FEARFUL OF COMING 1404 00:47:54,480 --> 00:47:56,520 TO HOSPITALS BECAUSE OF REALLY 1405 00:47:56,520 --> 00:47:57,400 DISSOCIATIONS, THEY WERE UNABLE 1406 00:47:57,400 --> 00:47:58,960 TO SEE THEIR FAMILY MEMBERS WHEN 1407 00:47:58,960 --> 00:47:59,800 HOSPITALIZED. 1408 00:47:59,800 --> 00:48:03,040 ALSO WITH LOCKDOWN POLICIES, 1409 00:48:03,040 --> 00:48:07,040 FAMILIES WERE FACING FLU NEW 1410 00:48:07,040 --> 00:48:09,240 CAREGIVER ROLES, NOT THE ILLNESS 1411 00:48:09,240 --> 00:48:10,360 OF COVID BUT EVERYTHING ELSE 1412 00:48:10,360 --> 00:48:11,440 THAT WENT ALONG WITH IT. 1413 00:48:11,440 --> 00:48:14,400 SO OUR RESEARCH QUESTIONS WERE 1414 00:48:14,400 --> 00:48:17,040 IS DELIRIUM A RECOGNIZED SYMPTOM 1415 00:48:17,040 --> 00:48:18,880 IN COVID AND IS COVID MORE 1416 00:48:18,880 --> 00:48:20,440 DEADLY TO OUR PATIENTS, IT STILL 1417 00:48:20,440 --> 00:48:21,680 REMAINS A SERIOUS CONCERN, AND 1418 00:48:21,680 --> 00:48:23,240 AGAIN WE HAD THESE RELUCTANCES, 1419 00:48:23,240 --> 00:48:24,640 THESE CHALLENGES THAT WE WERE 1420 00:48:24,640 --> 00:48:25,920 FACING IN COUNSELING OUR 1421 00:48:25,920 --> 00:48:26,160 FAMILIES. 1422 00:48:26,160 --> 00:48:27,640 WE ALSO BEGAN TO WONDER WHAT ARE 1423 00:48:27,640 --> 00:48:29,880 THE IMPACTS OF THIS ON OUR 1424 00:48:29,880 --> 00:48:30,880 CAREGIVING AND WHAT WERE THE 1425 00:48:30,880 --> 00:48:31,960 LONG TERM SEQUELAE EVEN BEFORE 1426 00:48:31,960 --> 00:48:35,080 WE WERE THINKING ABOUT POST 1427 00:48:35,080 --> 00:48:36,600 COVID SYNDROME, WE WERE WORRIED 1428 00:48:36,600 --> 00:48:37,960 ABOUT WHAT ARE THE LONG-TERM 1429 00:48:37,960 --> 00:48:41,480 IMPACTS OF THIS PROBLEM ON BRAIN 1430 00:48:41,480 --> 00:48:42,000 HEALTH. 1431 00:48:42,000 --> 00:48:43,560 LIKE DR. FRONTERA, WE TOOK A 1432 00:48:43,560 --> 00:48:45,040 LOOK AT OUR INPATIENT 1433 00:48:45,040 --> 00:48:46,840 POPULATION, AND WE WERE ABLE TO 1434 00:48:46,840 --> 00:48:50,160 LOOK AT ALL CASES AGE 65 AND UP 1435 00:48:50,160 --> 00:48:51,320 BETWEEN MARCH AND APRIL OF 2020 1436 00:48:51,320 --> 00:48:54,560 AND PUBLISHED THIS WITH A GROUP 1437 00:48:54,560 --> 00:48:56,320 OF COLLEAGUES AND JOURNAL OF 1438 00:48:56,320 --> 00:48:57,280 ALZHEIMER'S DISEASE IN MAY OF 1439 00:48:57,280 --> 00:48:57,720 2021. 1440 00:48:57,720 --> 00:48:59,520 WHAT WE FOUND BASICALLY WAS THAT 1441 00:48:59,520 --> 00:49:01,200 FOR THE MOST PART, THE SYMPTOMS 1442 00:49:01,200 --> 00:49:03,360 WE SAW IN OLDER INDIVIDUALS WITH 1443 00:49:03,360 --> 00:49:04,760 OR WITHOUT DEMENTIA WERE LARGELY 1444 00:49:04,760 --> 00:49:06,120 THE SAME WE SAW WITH THE GENERAL 1445 00:49:06,120 --> 00:49:07,200 POPULATION, WITH COUGH AND FEVER 1446 00:49:07,200 --> 00:49:08,280 BEING VERY COMMON, BUT WE SAW 1447 00:49:08,280 --> 00:49:09,720 SOME THINGS THAT WERE LESS 1448 00:49:09,720 --> 00:49:11,760 COMMON, LIKE DYSPNEA, DIARRHEA, 1449 00:49:11,760 --> 00:49:14,000 MUSCLE PAINS, CHILLS. 1450 00:49:14,000 --> 00:49:16,360 WE ALSO SAW CONFUSION WAS VERY 1451 00:49:16,360 --> 00:49:16,880 COMMON. 1452 00:49:16,880 --> 00:49:18,960 SUGGESTING THAT THERE IS 1453 00:49:18,960 --> 00:49:19,760 DELIRIUM ASSOCIATED WITH COVID 1454 00:49:19,760 --> 00:49:21,160 AS WE WERE SUSPECTING BUT 1455 00:49:21,160 --> 00:49:22,520 PERHAPS AN UNDERREPORTING, 1456 00:49:22,520 --> 00:49:24,160 PERHAPS RELATED TO THOSE WHO HAD 1457 00:49:24,160 --> 00:49:25,160 DEMENTIA NOT BEING AWARE OF 1458 00:49:25,160 --> 00:49:26,120 THEIR SYMPTOMS OR NOT 1459 00:49:26,120 --> 00:49:26,880 REMEMBERING TO REPORT THEIR 1460 00:49:26,880 --> 00:49:28,040 SYMPTOMS OR MAYBE A DIFFERENT 1461 00:49:28,040 --> 00:49:29,000 EXPERIENCE ALL TOGETHER. 1462 00:49:29,000 --> 00:49:30,760 SO WE FOUND THAT PERSONS WITH 1463 00:49:30,760 --> 00:49:31,840 DEMENTIA WERE THREE TIMES MORE 1464 00:49:31,840 --> 00:49:33,560 LIKELY TO PRESENT WITH DELIRIUM, 1465 00:49:33,560 --> 00:49:35,160 BUT THEY LESS OFTEN PRESENTED 1466 00:49:35,160 --> 00:49:36,480 WITH OTHER COVID SYMPTOMS AND IT 1467 00:49:36,480 --> 00:49:37,760 WAS ASSOCIATED, DEMENTIA WAS 1468 00:49:37,760 --> 00:49:38,720 ASSOCIATED WITH A HIGHER 1469 00:49:38,720 --> 00:49:39,840 MORTALITY BUT NOT OF A TAKING 1470 00:49:39,840 --> 00:49:41,560 INTO ACCOUNT OTHER COMORBIDITIES 1471 00:49:41,560 --> 00:49:42,880 AND AGE. 1472 00:49:42,880 --> 00:49:44,360 CODE STATUS WAS ALSO STRONGLY 1473 00:49:44,360 --> 00:49:45,600 ASSOCIATED WITH MORTALITY BUT 1474 00:49:45,600 --> 00:49:48,920 DID NOT SIGNIFICANTLY ATTENUATE 1475 00:49:48,920 --> 00:49:50,280 WITH OUR OTHER PREDICTORS. 1476 00:49:50,280 --> 00:49:52,680 THE LIMITATIONS WE RECOGNIZED, 1477 00:49:52,680 --> 00:49:56,200 IT WAS A SINGLE CENTER, CHART 1478 00:49:56,200 --> 00:50:00,160 ANALYSIS AND POSSIBLE BIAS OF 1479 00:50:00,160 --> 00:50:01,840 REPORTING, FOR GETTING. 1480 00:50:01,840 --> 00:50:03,680 OBVIOUSLY SINCE THEN, VACCINES 1481 00:50:03,680 --> 00:50:04,520 AND VARIANTS HAVE COME ALONG. 1482 00:50:04,520 --> 00:50:07,520 SO WE STARTED TO WONDER, 1483 00:50:07,520 --> 00:50:09,400 FINDINGS BY THE TIME WE'RE 1484 00:50:09,400 --> 00:50:10,560 REALLY ASIM LIGHT LATHING THAT 1485 00:50:10,560 --> 00:50:11,440 INFORMATION, WERE THE FINDINGS 1486 00:50:11,440 --> 00:50:12,640 WE HAD IN THE FIRST NEW YORK 1487 00:50:12,640 --> 00:50:13,960 CITY WAVE REALLY RELEVANT TO THE 1488 00:50:13,960 --> 00:50:14,960 NEXT NEW YORK CITY WAVE AND HOW 1489 00:50:14,960 --> 00:50:16,480 DID THEY RELATE TO THE FIRST 1490 00:50:16,480 --> 00:50:18,160 TRUE WAVE ACROSS THE UNITED 1491 00:50:18,160 --> 00:50:18,920 STATES? 1492 00:50:18,920 --> 00:50:21,680 SO THERE HAVE BEEN A LOT OF 1493 00:50:21,680 --> 00:50:22,320 CONCEPTS AROUND COVID-19 THAT 1494 00:50:22,320 --> 00:50:25,360 WE'VE BEEN THINKING ABOUT AND 1495 00:50:25,360 --> 00:50:26,040 EXPERIENCING OURSELVES. 1496 00:50:26,040 --> 00:50:27,760 AS WE ALL KNOW, THERE ARE 1497 00:50:27,760 --> 00:50:29,560 DIFFERENT VARIANTS, SO MANY 1498 00:50:29,560 --> 00:50:30,800 VARIATIONS TO THE PANDEMIC. 1499 00:50:30,800 --> 00:50:31,720 WE'VE HAD NEW VARIANT OF THE 1500 00:50:31,720 --> 00:50:33,680 DISEASE ITSELF, NEW 1501 00:50:33,680 --> 00:50:35,040 COMPLICATIONS, NEW RECOVERY 1502 00:50:35,040 --> 00:50:36,360 PATHWAY, AND A LOT OF THESE HAVE 1503 00:50:36,360 --> 00:50:38,120 BEEN REFLECTED EITHER THROUGH 1504 00:50:38,120 --> 00:50:41,640 THE COURSE OF EITHER NATURAL 1505 00:50:41,640 --> 00:50:42,760 IMMUNITY THROUGH EXPOSURE AND 1506 00:50:42,760 --> 00:50:44,040 ILLNESS, BUT ALSO NEW TREATMENTS 1507 00:50:44,040 --> 00:50:45,440 AND NEW VACCINES THAT HAVE COME 1508 00:50:45,440 --> 00:50:47,440 ALONG AND EVEN JUST THIS WEEK, 1509 00:50:47,440 --> 00:50:49,120 THE NEW BOOSTER IS ROLLING OUT. 1510 00:50:49,120 --> 00:50:50,400 WE'VE ALSO HAD DIFFERENT TIMING 1511 00:50:50,400 --> 00:50:52,200 AS I'VE MENTIONED SEVERAL TIMES 1512 00:50:52,200 --> 00:50:53,600 ALREADY, BETWEEN OUR AREA AND 1513 00:50:53,600 --> 00:50:55,720 OTHER LOCALITIES, AS WELL AS THE 1514 00:50:55,720 --> 00:50:57,920 NATION'S EXPERIENCE WITH IT. 1515 00:50:57,920 --> 00:50:59,680 AS I SAID BEFORE, THERE WERE 1516 00:50:59,680 --> 00:51:00,880 CO-OCCURRING FACTORS, NOT JUST 1517 00:51:00,880 --> 00:51:02,400 THE PSYCHOSOCIAL STRESS OF THE 1518 00:51:02,400 --> 00:51:03,960 PANDEMIC AND THE INITIAL 1519 00:51:03,960 --> 00:51:05,640 LOCKDOWNS ASSOCIATED WITH IT, 1520 00:51:05,640 --> 00:51:07,640 BUT OTHER UNIQUE SOCIAL 1521 00:51:07,640 --> 00:51:09,080 STRESSORS OCCURRING IN PARALLEL 1522 00:51:09,080 --> 00:51:11,280 THROUGHOUT THE UNITED STATES. 1523 00:51:11,280 --> 00:51:12,480 SO WHAT WE REALLY STARTED TO 1524 00:51:12,480 --> 00:51:13,480 UNDERSTAND IS, WE NEED TO 1525 00:51:13,480 --> 00:51:14,600 UNDERSTAND THE IMPACT OF COVID 1526 00:51:14,600 --> 00:51:17,440 ON A LARGE SCALE, SO MANY 1527 00:51:17,440 --> 00:51:19,160 CHANGES IN DISEASE, 1528 00:51:19,160 --> 00:51:19,960 HETEROGENEOUS EXPERIENCES AND 1529 00:51:19,960 --> 00:51:21,560 WHENEVER POSSIBLE LEVERAGE 1530 00:51:21,560 --> 00:51:22,800 EXISTING LARGE STUDIES ON AGING 1531 00:51:22,800 --> 00:51:24,240 TO HELP US IDENTIFY THE 1532 00:51:24,240 --> 00:51:24,600 TRAJECTORIES. 1533 00:51:24,600 --> 00:51:27,080 SO AS THE CLINICAL CORE LAY TORE 1534 00:51:27,080 --> 00:51:28,440 OF OUR ALZHEIMER'S CENTER I SEE 1535 00:51:28,440 --> 00:51:29,560 NO BETTER OPPORTUNITY THAN 1536 00:51:29,560 --> 00:51:31,920 REALLY OUR EXPERIENCE WITH THE 1537 00:51:31,920 --> 00:51:32,880 EDRCs, THE NATIONAL 1538 00:51:32,880 --> 00:51:33,520 ALZHEIMER'S COORDINATING CENTER. 1539 00:51:33,520 --> 00:51:36,080 THERE ARE NOW ABOUT 40 CENTERS 1540 00:51:36,080 --> 00:51:38,120 NATIONWIDE, FOLLOWING ABOUT 1541 00:51:38,120 --> 00:51:40,840 45,000 PARTICIPANTS OVER TIME. 1542 00:51:40,840 --> 00:51:42,040 SOME HAVE NOT BEEN SEEN FOR A 1543 00:51:42,040 --> 00:51:43,840 LONG WHILE BUT MANY ARE STILL 1544 00:51:43,840 --> 00:51:44,920 ACTIVELY BEING FOLLOWED AND 1545 00:51:44,920 --> 00:51:48,760 BASICALLY ERCH IN THIS EN 1546 00:51:48,760 --> 00:51:50,040 ANNUALLY, ALMOST ALL ARE AGE 60 1547 00:51:50,040 --> 00:51:51,280 AND ABOVE AND MOST ARE OLDER 1548 00:51:51,280 --> 00:51:52,920 THAN THAT, AND WE SEE A RANGE OF 1549 00:51:52,920 --> 00:51:54,120 COGNITIVE DIAGNOSES FROM NORMAL 1550 00:51:54,120 --> 00:51:56,480 TO PERSON WITH DEMENTIA IN MANY 1551 00:51:56,480 --> 00:51:59,000 CENTERS BUT NOT ALL, BLOOD WORK 1552 00:51:59,000 --> 00:52:01,200 AND GENETICS AND IMAGING. 1553 00:52:01,200 --> 00:52:03,000 IN COVID, WE BEGAN ASSESSING THE 1554 00:52:03,000 --> 00:52:04,120 IMPACT WITHIN THIS COHORT BACK 1555 00:52:04,120 --> 00:52:06,000 IN JUNE OF 2020, BUT THAT FORM 1556 00:52:06,000 --> 00:52:08,600 THAT WE USE WAS AT A TIME BEFORE 1557 00:52:08,600 --> 00:52:10,600 POST COVID SYNDROME HAD BEEN 1558 00:52:10,600 --> 00:52:12,480 DESCRIBED AND BEFORE ALL OF THE 1559 00:52:12,480 --> 00:52:14,680 MAJOR PSYCHOSOCIAL DISSTRESSORS 1560 00:52:14,680 --> 00:52:15,640 HAD REALLY BECOME APPARENT IN 1561 00:52:15,640 --> 00:52:17,240 THE POPULATION AND BEFORE WE 1562 00:52:17,240 --> 00:52:18,320 REALLY HAD RECOGNITION OF 1563 00:52:18,320 --> 00:52:19,720 RECURRING INFORECASTS WITH 1564 00:52:19,720 --> 00:52:21,520 COVID, BEFORE VACCINES AND 1565 00:52:21,520 --> 00:52:22,400 TREATMENTS, AND WE STARTED 1566 00:52:22,400 --> 00:52:24,040 REALIZING THAT THIS PANDEMIC 1567 00:52:24,040 --> 00:52:25,160 CLEARLY WAS NOT GOING TO RESOLVE 1568 00:52:25,160 --> 00:52:26,760 WITHIN A YEAR, BUT THAT WAS HOW 1569 00:52:26,760 --> 00:52:28,160 THE FORM WAS LARGELY CONSTRUCTED 1570 00:52:28,160 --> 00:52:28,600 AT THE TIME. 1571 00:52:28,600 --> 00:52:31,240 THOSE WERE THE PRESUMPTIONS. 1572 00:52:31,240 --> 00:52:37,320 SO HERE IS WHAT HE WE WE . 1573 00:52:37,320 --> 00:52:38,000 THE FIRST YEAR'S EXPERIENCE WITH 1574 00:52:38,000 --> 00:52:39,000 THIS FORM, THAT FIRST YEAR 1575 00:52:39,000 --> 00:52:40,040 REALLY PREDATES MOST OF THE 1576 00:52:40,040 --> 00:52:41,120 CASES WITHIN THE UNITED STATES, 1577 00:52:41,120 --> 00:52:43,280 BUT IT WAS TELLING, WHAT WE DID 1578 00:52:43,280 --> 00:52:43,840 LEARN. 1579 00:52:43,840 --> 00:52:44,800 THIS IS ACTUALLY THIS GRAPHIC AT 1580 00:52:44,800 --> 00:52:47,680 THE RIGHT WAS REALLY MORE CLOSER 1581 00:52:47,680 --> 00:52:48,920 TO 3500 FORMS THAT WERE 1582 00:52:48,920 --> 00:52:50,480 COMPLETED OVER THE COURSE OF 1583 00:52:50,480 --> 00:52:51,680 ABOUT A YEAR AND A HALF, BUT 1584 00:52:51,680 --> 00:52:52,720 LARGELY WHAT WE SAW IN THE FIRST 1585 00:52:52,720 --> 00:52:52,920 YEAR. 1586 00:52:52,920 --> 00:52:54,360 THAT IS THAT WE SAW FAR MORE 1587 00:52:54,360 --> 00:52:55,480 PEOPLE BEING TESTED THAN WERE 1588 00:52:55,480 --> 00:52:55,760 SICK. 1589 00:52:55,760 --> 00:52:58,000 WE SAW RELATIVELY SMALL NUMBER 1590 00:52:58,000 --> 00:52:58,680 OF INDIVIDUALS WHO WERE 1591 00:52:58,680 --> 00:53:00,120 HOSPITALIZED WITH COVID AND THEN 1592 00:53:00,120 --> 00:53:00,840 CAME BACK TO BE SEEN. 1593 00:53:00,840 --> 00:53:02,440 WE SAW A LOT OF PEOPLE WHO HAD 1594 00:53:02,440 --> 00:53:03,200 COGNITIVE CHANGES. 1595 00:53:03,200 --> 00:53:03,880 SO AGAIN, THIS IS SOMETHING 1596 00:53:03,880 --> 00:53:05,280 THAT'S HAPPENING IN PARALLEL TO 1597 00:53:05,280 --> 00:53:08,560 COGNITIVE AGING, BUT ALSO THE 1598 00:53:08,560 --> 00:53:11,360 OTHER DISTRESSORS HAPPENING IN 1599 00:53:11,360 --> 00:53:12,240 THE PERSON'S LIVES. 1600 00:53:12,240 --> 00:53:13,880 AS THIS FORM WAS ROLLING OUT, 1601 00:53:13,880 --> 00:53:15,520 INSTEAD OF THAT ONE-YEAR KIND OF 1602 00:53:15,520 --> 00:53:16,880 TIME LOCKED ASSESS M, WE WANTED 1603 00:53:16,880 --> 00:53:18,760 TO BETTER UNDERSTAND WHAT WERE 1604 00:53:18,760 --> 00:53:20,640 THE SUMMIT OF EXPERIENCES OF 1605 00:53:20,640 --> 00:53:22,160 PERSONS FOR WHAT WAS REALLY A 1606 00:53:22,160 --> 00:53:23,920 BRIEF ILLNESS FOR MOST 1607 00:53:23,920 --> 00:53:24,920 POTENTIALLY RECURRING FOR SOME 1608 00:53:24,920 --> 00:53:27,720 AND ALL THE WHILE, THEY'RE 1609 00:53:27,720 --> 00:53:29,120 RAPIDLY EVOLVING PROBLEM ACROSS 1610 00:53:29,120 --> 00:53:29,880 THE UNITED STATES. 1611 00:53:29,880 --> 00:53:32,360 SO I'VE BEEN CO-LEADING AN 1612 00:53:32,360 --> 00:53:33,400 INITIATIVE WITH SEVERAL OTHERS 1613 00:53:33,400 --> 00:53:36,800 AT OTHER ADRCs TO RE-THINK AND 1614 00:53:36,800 --> 00:53:38,520 ACTUALLY REDEPLOY A NEW COVID 1615 00:53:38,520 --> 00:53:42,320 IMPACT FORM RE NIEZING IN E 1616 00:53:42,320 --> 00:53:44,360 HAD MYRIAD STUDIES THAT HAVE 1617 00:53:44,360 --> 00:53:45,640 SUPPORTED THAT SEEMS TO BE THAT 1618 00:53:45,640 --> 00:53:47,960 COVID-19 FOR SOME SERVES AS AN 1619 00:53:47,960 --> 00:53:49,120 INFLECTION POINT FOR CLINICAL 1620 00:53:49,120 --> 00:53:50,080 DECLINE, AND THERE ARE SOME 1621 00:53:50,080 --> 00:53:51,080 STUDIES THAT HAVE SUGGESTED IN 1622 00:53:51,080 --> 00:53:54,080 ADDITION TO DR. FRONTERA'S THAT 1623 00:53:54,080 --> 00:53:55,640 PLASMA BIOMARKERS AND MRI 1624 00:53:55,640 --> 00:53:57,080 CHANGES EVOLVE RELATIVE TO 1625 00:53:57,080 --> 00:53:57,680 SOMEBODY'S EXPERIENCE WITH 1626 00:53:57,680 --> 00:53:58,560 COVID-19. 1627 00:53:58,560 --> 00:53:59,720 WE REALLY HAVE AN UNMATCHED 1628 00:53:59,720 --> 00:54:01,280 OPPORTUNITY FOR STUDY ACROSS 1629 00:54:01,280 --> 00:54:03,240 THESE 40 CENTERS, BETWEEN NOT 1630 00:54:03,240 --> 00:54:04,960 JUST HAVING A NATIONWIDE STUDY 1631 00:54:04,960 --> 00:54:06,720 BUT A REPRESENTATIVE STUDY FOR 1632 00:54:06,720 --> 00:54:09,640 MANY WHO ARE UNDERREPRESENTED IN 1633 00:54:09,640 --> 00:54:10,720 RESEARCH, AND WE REALLY HAVE 1634 00:54:10,720 --> 00:54:12,000 PRIMARY GOALS OF THIS UPDATED 1635 00:54:12,000 --> 00:54:13,360 FORM TO CAPTURE INFORMATION TO 1636 00:54:13,360 --> 00:54:15,000 INFORM KEY SCIENTIFIC QUESTIONS 1637 00:54:15,000 --> 00:54:17,720 REALLY ABOUT THE BIOLOGICAL 1638 00:54:17,720 --> 00:54:18,440 IMPACT OF COVID-19. 1639 00:54:18,440 --> 00:54:21,040 BOTH THE IMMEDIATE AND LONG TERM 1640 00:54:21,040 --> 00:54:21,560 SEQUELAE, REFLECTING ON 1641 00:54:21,560 --> 00:54:22,520 TREATMENTS THAT HAVE EVOLVED 1642 00:54:22,520 --> 00:54:23,840 OVER THAT TIME, IMPACT OF 1643 00:54:23,840 --> 00:54:24,760 VACCINATION, AND UNDERSTANDING 1644 00:54:24,760 --> 00:54:26,080 THAT THE TIMING AND TYPE OF 1645 00:54:26,080 --> 00:54:27,480 VACCINATION AND THE TIMING OF 1646 00:54:27,480 --> 00:54:30,120 INFECTION MAY ALSO MATTER. 1647 00:54:30,120 --> 00:54:31,520 AND TO THAT POINT, WE'RE GOING 1648 00:54:31,520 --> 00:54:33,120 TO TRY TO CAPTURE NOT THE 1649 00:54:33,120 --> 00:54:34,560 STRAINS NECESSARILY BECAUSE 1650 00:54:34,560 --> 00:54:36,640 PEOPLE DON'T OFTEN KNOW, BUT THE 1651 00:54:36,640 --> 00:54:39,120 TIMING OF THEIR INFECTION CAN 1652 00:54:39,120 --> 00:54:40,320 INFORM MAYBE WHAT STRAIN OR WHAT 1653 00:54:40,320 --> 00:54:41,520 SEVERITY THEY MAY HAVE 1654 00:54:41,520 --> 00:54:42,800 EXPERIENCED IN ADDITION TO THE 1655 00:54:42,800 --> 00:54:43,800 LEVEL OF CARE THAT THEY 1656 00:54:43,800 --> 00:54:44,080 RECEIVED. 1657 00:54:44,080 --> 00:54:46,200 AND THIS IS USED IN CONJUNCTION 1658 00:54:46,200 --> 00:54:47,160 REALLY TO DOVETAIL IN WITH OTHER 1659 00:54:47,160 --> 00:54:49,560 EXPERIENCES THAT WE HAVE ONGOING 1660 00:54:49,560 --> 00:54:51,440 IN THE NACC AND THE NATIONAL 1661 00:54:51,440 --> 00:54:52,520 ALZHEIMER'S COORDINATING CENTER 1662 00:54:52,520 --> 00:54:53,760 TO FURTHER UNDERSTAND NOT JUST 1663 00:54:53,760 --> 00:54:55,240 THE CLINICAL BURDEN AND 1664 00:54:55,240 --> 00:54:56,320 NEUROPSYCHOLOGICAL IMPACTS, BUT 1665 00:54:56,320 --> 00:54:57,680 UNDERSTAND WHAT HEALTHCARE 1666 00:54:57,680 --> 00:54:58,880 UTILIZATION TOOK PLACE OVER THAT 1667 00:54:58,880 --> 00:55:00,800 SAME TIME. 1668 00:55:00,800 --> 00:55:02,320 SO THIS IS A WORK IN PROGRESS. 1669 00:55:02,320 --> 00:55:03,720 WE HOPE TO BE ABLE TO REPORT OUT 1670 00:55:03,720 --> 00:55:04,360 SOME FINDINGS WITHIN THE NEXT 1671 00:55:04,360 --> 00:55:07,720 YEAR OR SO ABOUT WHAT THAT 1672 00:55:07,720 --> 00:55:09,680 SUPPLETIVE EXPERIENCE WAS IN 1673 00:55:09,680 --> 00:55:10,840 THIS COHORT AND I LOOK FORWARD 1674 00:55:10,840 --> 00:55:12,560 TO SHARING IT POTENTIALLY WITH 1675 00:55:12,560 --> 00:55:12,840 YOU THEN. 1676 00:55:12,840 --> 00:55:14,240 IF YOU HAVE ANY QUESTIONS, 1677 00:55:14,240 --> 00:55:15,680 PLEASE FEEL FREE TO REACH OUT. 1678 00:55:15,680 --> 00:55:16,240 THANK YOU, JAMES. 1679 00:55:16,240 --> 00:55:17,680 I'M GOING TO TALK ABOUT THE 1680 00:55:17,680 --> 00:55:19,560 IMPACT OF COVID BOTH ON NURSING 1681 00:55:19,560 --> 00:55:22,200 HOMES, BUT ALSO LONG-TERM CARE 1682 00:55:22,200 --> 00:55:22,480 SETTINGS. 1683 00:55:22,480 --> 00:55:24,760 THERE WILL BE SOME OVERLAP. 1684 00:55:24,760 --> 00:55:26,160 MY ONE MAJOR CONFLICT OF 1685 00:55:26,160 --> 00:55:28,800 INTEREST THAT I'M STILL DOING IN 1686 00:55:28,800 --> 00:55:30,680 MY RETIREMENT IS WE'RE 1687 00:55:30,680 --> 00:55:31,480 DEVELOPING COMPUTERIZED PROGRAMS 1688 00:55:31,480 --> 00:55:35,880 FOR OLDER PEOPLE TO DO GOOD 1689 00:55:35,880 --> 00:55:37,280 EVALUATIONS AS OPPOSED TO WHAT 1690 00:55:37,280 --> 00:55:37,960 TENDS TO HAPPEN. 1691 00:55:37,960 --> 00:55:40,080 I WANT TO POINT OUT THAT ALL THE 1692 00:55:40,080 --> 00:55:42,640 RAPID SCREENS THAT WE'VE 1693 00:55:42,640 --> 00:55:43,880 DEVELOPED AT ST. LOUIS 1694 00:55:43,880 --> 00:55:44,800 UNIVERSITY ARE IN THE PUBLIC 1695 00:55:44,800 --> 00:55:46,480 DOMAIN AND CAN BE USED BY 1696 00:55:46,480 --> 00:55:47,080 ANYONE. 1697 00:55:47,080 --> 00:55:48,440 THERE IS NO COST TO THEM, WHICH 1698 00:55:48,440 --> 00:55:57,400 IS IMPORTANT. 1699 00:55:57,400 --> 00:55:58,520 I CAN'T GET MY SLIDES TO GO 1700 00:55:58,520 --> 00:55:59,120 FORWARD. 1701 00:55:59,120 --> 00:55:59,320 OKAY. 1702 00:55:59,320 --> 00:56:02,320 SO THIS IS LONG COVID SYNDROME. 1703 00:56:02,320 --> 00:56:05,000 HERE IS A NATIVE AMERICAN WOMAN 1704 00:56:05,000 --> 00:56:07,240 SAYING, SEEMS LIKE IT'S BEEN A 1705 00:56:07,240 --> 00:56:08,840 LONG JOURNEY AND A LARGE TWO 1706 00:56:08,840 --> 00:56:09,640 MONTHS OF RECOVERY. 1707 00:56:09,640 --> 00:56:11,440 I'M MAKING PROGRESS AND STARTING 1708 00:56:11,440 --> 00:56:12,560 TO WALK INDEPENDENTLY WITH A 1709 00:56:12,560 --> 00:56:12,880 CANE. 1710 00:56:12,880 --> 00:56:14,200 A LITTLE AT A TIME, BUT GETTING 1711 00:56:14,200 --> 00:56:17,160 THERE. 1712 00:56:17,160 --> 00:56:20,080 WHEN WE LOOK AT COVID-19 AND 1713 00:56:20,080 --> 00:56:21,280 MORTALITY, WE HAVE TO REALIZE 1714 00:56:21,280 --> 00:56:24,120 THAT THE UNITED STATES HAS DONE 1715 00:56:24,120 --> 00:56:27,360 PRETTY TERRIBLY, AS AS U.K., 1716 00:56:27,360 --> 00:56:29,640 ITALY, AND OBVIOUSLY SOME OF THE 1717 00:56:29,640 --> 00:56:30,440 SOUTH AMERICA COUNTRIES COMPARED 1718 00:56:30,440 --> 00:56:32,360 TO OTHERS. 1719 00:56:32,360 --> 00:56:33,520 I WOULD LIKE TO STRESS THAT IF 1720 00:56:33,520 --> 00:56:35,760 YOU LOOK AT SINGAPORE AND 1721 00:56:35,760 --> 00:56:42,360 TAIWAN, WHERE FUNDAMENTALLY 1722 00:56:42,360 --> 00:56:44,840 UTILIZATION OF MASKS IS A NORMAL 1723 00:56:44,840 --> 00:56:45,960 BEHAVIOR WHEN THEY HAVE 1724 00:56:45,960 --> 00:56:47,280 INFECTIONS IN THE COMMUNITY HAVE 1725 00:56:47,280 --> 00:56:48,360 DONE REMARKABLY WELL, AND I WILL 1726 00:56:48,360 --> 00:56:50,840 KEEP ON POINTING OUT THAT THE 1727 00:56:50,840 --> 00:56:52,280 SCIENCE TRULY CONFIRMS THAT THE 1728 00:56:52,280 --> 00:56:55,160 USE OF MASKS IS IMPORTANT, AND 1729 00:56:55,160 --> 00:56:57,800 MOST PROBABLY AS IMPORTANT AS 1730 00:56:57,800 --> 00:56:58,120 VACCINES. 1731 00:56:58,120 --> 00:56:59,760 SO I NEED TO SAY THIS BECAUSE 1732 00:56:59,760 --> 00:57:02,480 WE'VE MOVED INTO AN ERA WHERE 1733 00:57:02,480 --> 00:57:03,880 PEOPLE DON'T SEEM TO THINK MASKS 1734 00:57:03,880 --> 00:57:05,920 ARE THAT IMPORTANT. 1735 00:57:05,920 --> 00:57:07,400 AS HAS BEEN POINTED OUT BY 1736 00:57:07,400 --> 00:57:09,080 OTHERS, THE PEOPLE WHO TEND TO 1737 00:57:09,080 --> 00:57:11,600 DIE ARE THE OLDER PEOPLE. 1738 00:57:11,600 --> 00:57:15,600 WHEN WE LOOK AT COVID-19 IN 1739 00:57:15,600 --> 00:57:17,400 NURSING HOMES, MANY NURSING 1740 00:57:17,400 --> 00:57:18,880 HOMES HAVE HAD MULTIPLE 1741 00:57:18,880 --> 00:57:22,400 OUTBREAKS, WEEKS OF SUSTAINED 1742 00:57:22,400 --> 00:57:23,120 TRANSMISSION OVER THE PERIOD OF 1743 00:57:23,120 --> 00:57:24,040 TIME, AND SOME NURSING HOMES ARE 1744 00:57:24,040 --> 00:57:25,760 UP TO THEIR FOURTH OUTBREAK AT 1745 00:57:25,760 --> 00:57:27,960 THIS STAGE, AND SOME OF THESE 1746 00:57:27,960 --> 00:57:29,000 OUTBREAKS ARE SHORT, SOME OF 1747 00:57:29,000 --> 00:57:31,840 THEM ARE LONG. 1748 00:57:31,840 --> 00:57:33,040 AND THIS SLIDE SHOWS WHAT I 1749 00:57:33,040 --> 00:57:36,000 THINK WE ALL KNOW, THAT COVID 1750 00:57:36,000 --> 00:57:39,360 COMES IN SORT OF BURSTS, THAT 1751 00:57:39,360 --> 00:57:41,280 WHERE YOU HAVE THESE BURSTS, 1752 00:57:41,280 --> 00:57:42,280 DEATHS TEND TO GO UP. 1753 00:57:42,280 --> 00:57:44,040 THE MOST RECENT BURST, WHICH HAS 1754 00:57:44,040 --> 00:57:45,200 BEEN TAKING PLACE TOWARD THE END 1755 00:57:45,200 --> 00:57:47,600 OF AUGUST, BEGINNING OF 1756 00:57:47,600 --> 00:57:49,440 SEPTEMBER, APPEARS TO BE 1757 00:57:49,440 --> 00:57:51,920 ASSOCIATED WITH LESS DEATH THAN 1758 00:57:51,920 --> 00:57:52,440 THE OTHERS. 1759 00:57:52,440 --> 00:57:55,280 THIS IS PARTICULARLY TRUE AT 1760 00:57:55,280 --> 00:57:57,400 NURSING HOMES, WHERE WE HAVE HAD 1761 00:57:57,400 --> 00:57:58,240 MUCH MORE VACCINATION. 1762 00:57:58,240 --> 00:58:01,520 SO IF YOU LOOK AT IT IN A 1763 00:58:01,520 --> 00:58:05,520 NURSING HOME, BASICALLY THE CDC 1764 00:58:05,520 --> 00:58:07,680 AND CMS SAID THAT WE NEEDED TO 1765 00:58:07,680 --> 00:58:10,320 GET EVERYBODY VACCINATED, AND WE 1766 00:58:10,320 --> 00:58:14,040 GOT ABOUT 87% OF RESIDENTS 1767 00:58:14,040 --> 00:58:15,840 VACCINATED WITH THEIR PRIMARY 1768 00:58:15,840 --> 00:58:19,680 VACCINATION, BUT AT THE MOMENT, 1769 00:58:19,680 --> 00:58:21,080 ONLY 56% OF RESIDENTS ARE 1770 00:58:21,080 --> 00:58:21,320 UPDATED. 1771 00:58:21,320 --> 00:58:22,040 THIS IS A PROBLEM. 1772 00:58:22,040 --> 00:58:25,160 IF YOU DON'T GET THE BOOSTERS, 1773 00:58:25,160 --> 00:58:26,880 IT APPEARS THAT THE VACCINATION 1774 00:58:26,880 --> 00:58:29,080 IS A LITTLE BIT LIKE THE FLU 1775 00:58:29,080 --> 00:58:29,600 VACCINATION. 1776 00:58:29,600 --> 00:58:31,080 IT WORKS FOR A SHORT PERIOD OF 1777 00:58:31,080 --> 00:58:35,080 TIME, AND THEN IT DISAPPEARS. 1778 00:58:35,080 --> 00:58:37,480 THE OTHER PROBLEM IS STAFF 1779 00:58:37,480 --> 00:58:39,160 ORIGINALLY WELL VACCINATED BUT 1780 00:58:39,160 --> 00:58:40,600 STAFF ARE NOT FOLLOWING UP WITH 1781 00:58:40,600 --> 00:58:41,880 VACCINATIONS, AND WHEN WE LOOK 1782 00:58:41,880 --> 00:58:43,880 AT THE CONFIRMED CASES, WE HAVE 1783 00:58:43,880 --> 00:58:45,600 OVER A MILLION CONFIRMED 1784 00:58:45,600 --> 00:58:53,400 RESIDENT CASES OF COVID WITH 1785 00:58:53,400 --> 00:58:57,200 ABOUT 155,000 DEATHS, AND STAFF, 1786 00:58:57,200 --> 00:58:58,840 ALSO VERY HIGH NUMBERS, THOUGH 1787 00:58:58,840 --> 00:59:00,360 MUCH LOWER DEATH RATE WAS IN THE 1788 00:59:00,360 --> 00:59:02,440 STAFF. 1789 00:59:02,440 --> 00:59:03,880 I PUT THIS IN BECAUSE I THINK 1790 00:59:03,880 --> 00:59:07,720 THIS SAYS WHAT I WANT TO SAY. 1791 00:59:07,720 --> 00:59:09,720 I HAVE, AS FAR AS I KNOW, NOT 1792 00:59:09,720 --> 00:59:10,320 HAD COVID. 1793 00:59:10,320 --> 00:59:13,280 I AM FULLY VACCINATED BUT ALSO 1794 00:59:13,280 --> 00:59:14,840 MY WIFE AND I WEAR MASKS 1795 00:59:14,840 --> 00:59:15,880 WHENEVER WE GO OUT IN PUBLIC. 1796 00:59:15,880 --> 00:59:17,600 AND MY DOGS, I HAVEN'T MANAGED 1797 00:59:17,600 --> 00:59:19,360 TO MASK YET, BUT WHEN I WALK THE 1798 00:59:19,360 --> 00:59:21,000 DOGS, I ALSO WEAR A MASK. 1799 00:59:21,000 --> 00:59:23,040 SO I THINK IT'S REALLY IMPORTANT 1800 00:59:23,040 --> 00:59:26,000 TO REALIZE THAT THE MASKS ARE 1801 00:59:26,000 --> 00:59:26,600 IMPORTANT. 1802 00:59:26,600 --> 00:59:29,360 WE KNOW THAT THIS IS A DISEASE 1803 00:59:29,360 --> 00:59:35,160 THAT IS AIRBORNE AND AEROSOL 1804 00:59:35,160 --> 00:59:37,760 SENT OUT, AND WE ALSO KNOW THAT 1805 00:59:37,760 --> 00:59:39,400 THE N95 IS BETTER THAN THE 1806 00:59:39,400 --> 00:59:42,560 AVERAGE SURGICAL MASK, THOUGH I 1807 00:59:42,560 --> 00:59:43,880 THINK THAT ANY SORT OF MASK IS 1808 00:59:43,880 --> 00:59:47,160 BETTER THAN NONE. 1809 00:59:47,160 --> 00:59:48,520 WE ALSO HAVE TO RECOGNIZE THAT 1810 00:59:48,520 --> 00:59:52,160 WITH LOCKDOWN IN IN THE NURSIG 1811 00:59:52,160 --> 00:59:54,000 HOMES, A LOT OF NURSING HOMES 1812 00:59:54,000 --> 00:59:55,200 HAVE SLOWLY MOVED TOWARDS 1813 00:59:55,200 --> 00:59:55,960 TELEHEALTH AND I THINK 1814 00:59:55,960 --> 00:59:57,160 EFFICIENTLY WE WILL HAVE A HIGH 1815 00:59:57,160 --> 00:59:58,640 QUALITY OF TELEHEALTH, WHICH 1816 00:59:58,640 --> 01:00:00,280 WILL IMPROVE CARE IN THE NURSING 1817 01:00:00,280 --> 01:00:01,240 HOMES. 1818 01:00:01,240 --> 01:00:02,600 HOW WELL TELEHEALTH HAS DONE 1819 01:00:02,600 --> 01:00:04,080 OVER THE COVID PERIOD, WE DON'T 1820 01:00:04,080 --> 01:00:05,480 REALLY KNOW. 1821 01:00:05,480 --> 01:00:07,680 THE DIAGNOSIS OF COVID WHICH IN 1822 01:00:07,680 --> 01:00:11,160 NURSING HOMES IS DONE REGULARLY, 1823 01:00:11,160 --> 01:00:13,280 BECAUSE OF A REQUIREMENT, THE 1824 01:00:13,280 --> 01:00:15,320 PCR IS 97% ACCURATE. 1825 01:00:15,320 --> 01:00:17,560 IT DOESN'T DO A GOOD JOB IN THE 1826 01:00:17,560 --> 01:00:19,440 FIRST TWO DAYS, AND IT DETECTS 1827 01:00:19,440 --> 01:00:23,920 THOSE WHO ARE INFECTED. 1828 01:00:23,920 --> 01:00:25,760 ANTIBODIES, IGG STAYS UP LONGER 1829 01:00:25,760 --> 01:00:28,880 THAN IGM, AND DETECTS THOSE WHO 1830 01:00:28,880 --> 01:00:29,680 HAVE HAD DISEASE. 1831 01:00:29,680 --> 01:00:37,360 SO IF WE LOOK AT NURSING HOME -- 1832 01:00:37,360 --> 01:00:44,640 THIS IS FROM THE SPANISH ARMY 1833 01:00:44,640 --> 01:00:45,720 WHO WENT -- WHERE THEY FOUND 1834 01:00:45,720 --> 01:00:47,000 MOST OF THE RESIDENT WERE DEAD 1835 01:00:47,000 --> 01:00:48,880 AND ABANDONED. 1836 01:00:48,880 --> 01:00:50,520 IT'S IMPORTANT TO RECOGNIZE THAT 1837 01:00:50,520 --> 01:00:53,800 MANY PERSONS IN NURSING HOMES 1838 01:00:53,800 --> 01:00:54,960 ARE POSITIVE WITHOUT SYMPTOMS, 1839 01:00:54,960 --> 01:00:59,240 SO REGULAR TREATMENT LOOKING FOR 1840 01:00:59,240 --> 01:01:02,200 SYMPTOMS IS IMPORTANT, TESTING, 1841 01:01:02,200 --> 01:01:04,040 AND THE EXISTENCE OF PERSONAL 1842 01:01:04,040 --> 01:01:07,000 PROTECTIVE EQUIPMENT IS VERY 1843 01:01:07,000 --> 01:01:07,280 IMPORTANT. 1844 01:01:07,280 --> 01:01:08,280 I STRONGLY FEEL THAT WE SHOULD 1845 01:01:08,280 --> 01:01:11,000 NOT TAKE UNTESTED HOSPITAL 1846 01:01:11,000 --> 01:01:11,960 PATIENTS, THE HOSPITAL SHOULD 1847 01:01:11,960 --> 01:01:13,640 TEST BEFORE THEY ARE SENT TO THE 1848 01:01:13,640 --> 01:01:14,800 NURSING HOME, AND WITHIN THE 1849 01:01:14,800 --> 01:01:17,600 NURSING HOME, IF PEOPLE ARE 1850 01:01:17,600 --> 01:01:19,320 SICK, YOU NEED TO HAVE ISOLATION 1851 01:01:19,320 --> 01:01:21,680 WHICH IS A PROBLEM SEEING OFTEN 1852 01:01:21,680 --> 01:01:25,480 PEOPLE SHARE A ROOM, AND THAT 1853 01:01:25,480 --> 01:01:26,640 REQUIRES HOW DO YOU TREAT THE 1854 01:01:26,640 --> 01:01:28,840 PERSON WHO IS NOT INFECTED WITH 1855 01:01:28,840 --> 01:01:29,800 A PERSON WHILE YOU MAKE SURE 1856 01:01:29,800 --> 01:01:31,160 THEY'RE NOT GOING TO GET 1857 01:01:31,160 --> 01:01:31,960 INFECTED. 1858 01:01:31,960 --> 01:01:33,160 OBVIOUSLY WHY NURSING HOMES DO 1859 01:01:33,160 --> 01:01:38,400 SO POORLY IS THESE ARE A VERY 1860 01:01:38,400 --> 01:01:39,400 VULNERABLE POPULATION AND LARGE 1861 01:01:39,400 --> 01:01:41,040 AMOUNTS OF INTERACTION AMONGST 1862 01:01:41,040 --> 01:01:42,000 THE POPULATION. 1863 01:01:42,000 --> 01:01:44,600 WHEN WE LOOK AT REHABILITATION 1864 01:01:44,600 --> 01:01:47,680 AND LONG COVID, POST COVID 1865 01:01:47,680 --> 01:01:49,520 CONDITIONS MAY ALSO BE KNOWN AS 1866 01:01:49,520 --> 01:01:52,280 LONG COI HAVE, LANGEVIN HAUL 1867 01:01:52,280 --> 01:01:54,320 COVID, POST-ACUTE COVID, 1868 01:01:54,320 --> 01:01:55,880 LONG-TERM EFFECTS OF COVID OR 1869 01:01:55,880 --> 01:01:58,280 CHRONIC COVID. 1870 01:01:58,280 --> 01:02:00,880 THEY'RE DIAGNOSED WHEN PRESENTS 1871 01:02:00,880 --> 01:02:02,960 HAVE BEEN PRESENT FOR THREE 1872 01:02:02,960 --> 01:02:05,200 MONTHS AFTER A COVID EVENT. 1873 01:02:05,200 --> 01:02:08,720 THEY'RE PRESENT IN 5 TO 45%, BUT 1874 01:02:08,720 --> 01:02:11,320 AS WE'VE SEEN FROM THE TALKS, 1875 01:02:11,320 --> 01:02:13,480 60% MAY STILL HAVE SOME SYMPTOMS 1876 01:02:13,480 --> 01:02:14,440 A YEAR AFTER THEIR COVID. 1877 01:02:14,440 --> 01:02:17,240 WHEN IT INVOLVES THE BRAIN, THIS 1878 01:02:17,240 --> 01:02:21,760 IS MYALGIC ENCEPHALOMYELITIS, 1879 01:02:21,760 --> 01:02:24,520 AND IF WE LOOK HERE AT PATIENTS 1880 01:02:24,520 --> 01:02:27,080 REPORTING COVID SYMPTOMS CAN BE 1881 01:02:27,080 --> 01:02:29,920 REALLY, BY 18 MONTHS, STILL 15% 1882 01:02:29,920 --> 01:02:31,760 OF PEOPLE HAVE THEM. 1883 01:02:31,760 --> 01:02:32,560 WHAT ARE THE SYMPTOMS? 1884 01:02:32,560 --> 01:02:35,160 WE'VE HEARD ABOUT SOME OF THEM. 1885 01:02:35,160 --> 01:02:36,480 OBVIOUSLY CONFUSION, EITHER AS 1886 01:02:36,480 --> 01:02:39,520 IT DELIRIUM OR DEMENTIA. 1887 01:02:39,520 --> 01:02:40,960 WORSENING DEMENTIA. 1888 01:02:40,960 --> 01:02:42,160 FATIGUE IS A BIG ONE, HEADACHE 1889 01:02:42,160 --> 01:02:43,520 IS A BIG ONE. 1890 01:02:43,520 --> 01:02:44,240 ALWAYS LOOK AT THE EYES. 1891 01:02:44,240 --> 01:02:49,440 THEY CAN BE RED, AN ANOREXIC, 1892 01:02:49,440 --> 01:02:50,520 DYSPNEA, WE'VE HEARD ABOUT 1893 01:02:50,520 --> 01:02:50,840 COUGH. 1894 01:02:50,840 --> 01:02:54,440 LOSS OF TASTE AND SMELL ARE 1895 01:02:54,440 --> 01:02:57,080 IMPORTANT AND DON'T GO AWAY 1896 01:02:57,080 --> 01:02:57,480 NECESSARILY. 1897 01:02:57,480 --> 01:02:59,080 CHEST PAIN OFTEN REMAINS, SOME 1898 01:02:59,080 --> 01:03:02,520 KIDNEY FAILURE, AUTONOMIC 1899 01:03:02,520 --> 01:03:06,920 NEUROPATHY INCLUDING POTTS IS PT 1900 01:03:06,920 --> 01:03:08,120 UNCOMMON IN MANY OF THESE 1901 01:03:08,120 --> 01:03:09,360 PATIENTS AND IS NOT WELL LOOKED 1902 01:03:09,360 --> 01:03:09,640 FOR. 1903 01:03:09,640 --> 01:03:12,360 PEOPLE HAVE JOINT PAINS AND 1904 01:03:12,360 --> 01:03:14,160 MYALGIA, SARCOPENIA AND CACHEXIA 1905 01:03:14,160 --> 01:03:16,080 DUE TO LOSS OF MUSCLE IS FAIRLY 1906 01:03:16,080 --> 01:03:20,320 COMMON, AND FALLS INCREASE. 1907 01:03:20,320 --> 01:03:21,720 THESE ARE PERSISTENT SYMPTOMS WE 1908 01:03:21,720 --> 01:03:23,840 HAVE TO LOOK FOR. 1909 01:03:23,840 --> 01:03:25,640 THE BEST EXAMPLE OF THIS THAT I 1910 01:03:25,640 --> 01:03:29,680 KNOW WAS A PICTURE PITCHER E 1911 01:03:29,680 --> 01:03:31,280 BOSTON RED SOX, EDUARDO 1912 01:03:31,280 --> 01:03:33,360 RODRIGUEZ, TO TOOK OVER A YEAR 1913 01:03:33,360 --> 01:03:34,920 TO RECOVER FROM HIS LONG COVID 1914 01:03:34,920 --> 01:03:36,360 SYMPTOMS AND HAD TO SIT OUT THE 1915 01:03:36,360 --> 01:03:38,480 SEASON FOR PLAYING FOR THE RED 1916 01:03:38,480 --> 01:03:40,120 SOX LAST YEAR. 1917 01:03:40,120 --> 01:03:45,920 CARDIOPULL MOTHERY EFFECTS, E 1918 01:03:45,920 --> 01:03:56,160 HAVE WHAT APPEARS TO BE 1919 01:03:56,160 --> 01:03:58,640 PULMONARY EMBOLI. 1920 01:03:58,640 --> 01:03:59,960 PULMONARY EMBOLISM IN LONG COVID 1921 01:03:59,960 --> 01:04:01,280 APPEARS TO BE PERIPHERAL, NOT 1922 01:04:01,280 --> 01:04:05,040 CENTRAL. 1923 01:04:05,040 --> 01:04:06,120 MYOCARDITE, EXTRAORDINARILY 1924 01:04:06,120 --> 01:04:07,560 COMMON. 1925 01:04:07,560 --> 01:04:08,600 MYOCARDIAL DISEASE CAN GO ON FOR 1926 01:04:08,600 --> 01:04:10,520 A YEAR OR SO AFTER LONG COVID, 1927 01:04:10,520 --> 01:04:11,240 MAYBE NOT RECOVER. 1928 01:04:11,240 --> 01:04:16,280 YOU NEED TO AVOID QTC PROLONGING 1929 01:04:16,280 --> 01:04:18,120 DRUGS AND ARRHYTHMIAS ARE NOT 1930 01:04:18,120 --> 01:04:18,640 UNUSUAL. 1931 01:04:18,640 --> 01:04:20,520 THE POST INFLAMMATORY LUNG 1932 01:04:20,520 --> 01:04:23,000 DAMAGE WHICH CAUSES DYSPNEA, WE 1933 01:04:23,000 --> 01:04:26,600 NEED TO DO LUNG FUNCTION TESTS, 1934 01:04:26,600 --> 01:04:27,760 IF PEOPLE ARE BREATHLESS, WE 1935 01:04:27,760 --> 01:04:29,600 NEED BREATHING EXERCISES AND 1936 01:04:29,600 --> 01:04:38,520 HOME PULSE OXIMETRY. 1937 01:04:38,520 --> 01:04:40,200 METHACHOLINE CHALLENGE IS 1938 01:04:40,200 --> 01:04:43,240 COMMON, AND PULL PULMONARY 1939 01:04:43,240 --> 01:04:44,320 REHABILITATION NEEDS TO BE DONE 1940 01:04:44,320 --> 01:04:45,920 AND HAS NOT BEEN DONE WELL AT 1941 01:04:45,920 --> 01:04:48,760 THIS MOMENT IN TIME AND MANY 1942 01:04:48,760 --> 01:04:51,400 PEOPLE WHO GOT LONG COVID. 1943 01:04:51,400 --> 01:04:55,200 THE SIX-MINUTE WALK TEST WAS NOT 1944 01:04:55,200 --> 01:04:57,520 DONE IN THE MAJORITY OF PATIENTS 1945 01:04:57,520 --> 01:05:00,000 BUT WHEN DONE, IT TENDS TO HAVE 1946 01:05:00,000 --> 01:05:06,000 POOR OUTCOMES EARLIER. 1947 01:05:06,000 --> 01:05:06,960 STIMULATION THERAPY CAN BE DONE 1948 01:05:06,960 --> 01:05:13,480 THE SAME WAY IT'S DONE FOR OTHER 1949 01:05:13,480 --> 01:05:16,600 CAUSES, AND YOU CAN GET ABOUT 1950 01:05:16,600 --> 01:05:18,520 TWO OUT OF THREE PEOPLE POST 1951 01:05:18,520 --> 01:05:20,000 INFECTIOUS, AND ONE OUT OF THREE 1952 01:05:20,000 --> 01:05:21,960 PEOPLE POST TRAWL MATIC WHO 1953 01:05:21,960 --> 01:05:23,440 IMPROVE. 1954 01:05:23,440 --> 01:05:25,240 THAT'S BASICALLY BEFORE COVID. 1955 01:05:25,240 --> 01:05:27,080 MOST PROBABLY THE SAME WITH 1956 01:05:27,080 --> 01:05:27,520 COVID. 1957 01:05:27,520 --> 01:05:29,160 FATIGUE IS AN IMPORTANT 1958 01:05:29,160 --> 01:05:31,800 COMPONENT OF COVID. 1959 01:05:31,800 --> 01:05:33,760 SARCOPENIA GOES ALONG WITH THE 1960 01:05:33,760 --> 01:05:37,800 FATIGUE, WEIGHT LOSS, TIS FOR D, 1961 01:05:37,800 --> 01:05:43,080 KEADY 1962 01:05:43,080 --> 01:05:44,080 DEPRESSION, PHYSICAL FRAILTY. 1963 01:05:44,080 --> 01:05:45,280 YOU CAN USE THE FRAIL TEST FOR 1964 01:05:45,280 --> 01:05:46,240 THAT. 1965 01:05:46,240 --> 01:05:50,000 THE TREATMENT INCLUDES GRADED 1966 01:05:50,000 --> 01:05:52,920 EXERCISE, LEUCINE ENRICHED AMINO 1967 01:05:52,920 --> 01:05:55,080 ACIDS, SUPPORTS AND 1968 01:05:55,080 --> 01:05:56,600 PSYCHOLOGICAL THERAPY, REFER TO 1969 01:05:56,600 --> 01:05:59,120 A PSYCHIATRIST IF THE PHQ9 IS 1970 01:05:59,120 --> 01:06:01,680 GREATER THAN 15, AND A NOCTURNAL 1971 01:06:01,680 --> 01:06:03,160 PULSE OX IF POSITIVE C PAP. 1972 01:06:03,160 --> 01:06:04,800 BRAIN FOG, WE'VE HEARD LOTS 1973 01:06:04,800 --> 01:06:11,640 ABOUT, AND WE HAVE TO RECOGNIZE 1974 01:06:11,640 --> 01:06:12,920 THE -- IT'S FREE, WORKS AS WELL 1975 01:06:12,920 --> 01:06:17,760 AS A MARKER, BOTH WORK BETTER 1976 01:06:17,760 --> 01:06:23,640 THAN THE DESH MENTAL -- M. 1977 01:06:23,640 --> 01:06:25,680 BRAIN STIMULATION GAMES, 1978 01:06:25,680 --> 01:06:27,120 COGNITIVE STIMULATION THERAPY, 1979 01:06:27,120 --> 01:06:28,320 EXERCISE, EX-CLUES DEPRESSION 1980 01:06:28,320 --> 01:06:34,840 AND SLEEP APNEA. 1981 01:06:34,840 --> 01:06:36,400 -- THESE HAVE BEEN SHOWN TO 1982 01:06:36,400 --> 01:06:38,760 DESTROY AND DAMAGE ENDOTHELIAL 1983 01:06:38,760 --> 01:06:40,200 CELLS WHICH CAN LEAD TO PROBLEMS 1984 01:06:40,200 --> 01:06:41,040 WITHIN THE BRAIN AS WELL AS 1985 01:06:41,040 --> 01:06:42,040 THROUGHOUT THE BODY. 1986 01:06:42,040 --> 01:06:43,440 THEY ALSO LEAD TO CACHEXIA AND 1987 01:06:43,440 --> 01:06:48,280 THEY LEAD TO A THICK ALVEOLIE 1988 01:06:48,280 --> 01:06:49,400 PRODUCING DYSPNEA. 1989 01:06:49,400 --> 01:06:51,240 THE EFFECT ON THE HEART INCLUDE 1990 01:06:51,240 --> 01:06:54,280 CHEST PAIN, DYSPNEA AND AUTO NO 1991 01:06:54,280 --> 01:06:57,840 MIBG 1992 01:06:57,840 --> 01:06:58,600 AUTONOMIC DYSFUNCTION. 1993 01:06:58,600 --> 01:07:00,120 POST VIRAL SYNDROME, WHICH I 1994 01:07:00,120 --> 01:07:03,960 FIRST SAW NEARLY 50 YEARS AGO AS 1995 01:07:03,960 --> 01:07:06,800 AN INTERN IN SOUTH AFRICA, 1996 01:07:06,800 --> 01:07:07,600 EPSTEIN-BARR VIRUS AT THAT TIME, 1997 01:07:07,600 --> 01:07:10,600 BUT ANY OF THE VIRAL DISEASES DO 1998 01:07:10,600 --> 01:07:11,800 THIS, AND IT'S IMPORTANT TO 1999 01:07:11,800 --> 01:07:12,960 RECOGNIZE THIS THERE ARE A 2000 01:07:12,960 --> 01:07:15,720 NUMBER OF THINGS YOU CAN MEASURE 2001 01:07:15,720 --> 01:07:18,280 LIKE THE D-DIMER AND THE ESR, 2002 01:07:18,280 --> 01:07:20,400 WHICH WERE ELEVATED AND HELP YOU 2003 01:07:20,400 --> 01:07:23,320 A LITTLE BIT, BUT WE HAVE TO 2004 01:07:23,320 --> 01:07:24,320 LISTEN -- RECOGNIZE THIS. 2005 01:07:24,320 --> 01:07:27,240 SOCIAL ISOLATION, OR THE 2006 01:07:27,240 --> 01:07:28,360 LONELINESS EPIDEMIC, IS 2007 01:07:28,360 --> 01:07:30,040 EXTRAORDINARILY COMMON IN OLDER 2008 01:07:30,040 --> 01:07:31,920 PEOPLE, AND IN OUR NURSING HOME 2009 01:07:31,920 --> 01:07:35,360 BEFORE THE EPIDEMIC, WE HAD 20% 2010 01:07:35,360 --> 01:07:41,160 OF PEOPLE IN NURSING HOMES THAT 2011 01:07:41,160 --> 01:07:46,160 HAD LONELINESS. 2012 01:07:46,160 --> 01:07:47,440 ACTIVITY WE PUSHED OP NURSING 2013 01:07:47,440 --> 01:07:48,160 HOME. 2014 01:07:48,160 --> 01:07:50,240 POST COVID THIS HAS GONE UP 2015 01:07:50,240 --> 01:07:51,640 QUITE A BIT. 2016 01:07:51,640 --> 01:07:53,320 AS HEMINGWAY SAID, NO ONE SHOULD 2017 01:07:53,320 --> 01:07:55,360 BE ALONE IN OLDER AGE BUT IT 2018 01:07:55,360 --> 01:08:00,200 APPEARS TO BE UNA UNAVOIDABLE. 2019 01:08:00,200 --> 01:08:01,520 WE RAN INTO THIS IN A BIG WAY IN 2020 01:08:01,520 --> 01:08:02,960 OUR NURSING HOMES. 2021 01:08:02,960 --> 01:08:05,640 SO TO CONCLUDE, I SHOULD POINT 2022 01:08:05,640 --> 01:08:10,600 OUT THAT A GREAT PAPER BY 2023 01:08:10,600 --> 01:08:12,640 SORENSEN, A CALL TO ACTION TO 2024 01:08:12,640 --> 01:08:13,280 UNDERSTAND, ENHANCE 2025 01:08:13,280 --> 01:08:17,560 UNDERSTANDING OF LONG COVID IN 2026 01:08:17,560 --> 01:08:18,200 LONG-TERM CARE HOME RESIDENTS. 2027 01:08:18,200 --> 01:08:19,600 WE MAKE THE CALL TO ACTION TO 2028 01:08:19,600 --> 01:08:20,680 THE RESEARCH COMMUNITY TO 2029 01:08:20,680 --> 01:08:24,440 RAPIDLY ADDRESS THE DEARTH OF 2030 01:08:24,440 --> 01:08:28,000 RESEARCH ON LONG COVID IN 2031 01:08:28,000 --> 01:08:28,560 RESIDENTS IN LONG-TERM CARE 2032 01:08:28,560 --> 01:08:33,120 HOMES. 2033 01:08:33,120 --> 01:08:34,360 CHALLENGES -- GUIDELINES FOR 2034 01:08:34,360 --> 01:08:36,200 LONG COVID MANAGEMENT AND ITS 2035 01:08:36,200 --> 01:08:38,360 UNIQUE CONTEXT, AND LONG HAUL 2036 01:08:38,360 --> 01:08:39,800 COVID STILL HAS A LONG WAY TO GO 2037 01:08:39,800 --> 01:08:41,960 FOR PATIENT AND CLINICIANS, AND 2038 01:08:41,960 --> 01:08:44,160 EVERY TIME I HEAR SOME 2039 01:08:44,160 --> 01:08:46,520 POLITICIAN OR DOCTOR TELLING US 2040 01:08:46,520 --> 01:08:48,400 THAT FUNDAMENTALLY COVID 2041 01:08:48,400 --> 01:08:51,800 PANDEMIC IS OVER, AND WE CANNOT 2042 01:08:51,800 --> 01:08:55,720 WEAR MASKS CAN NOT 2043 01:08:55,720 --> 01:08:58,040 WEAR MASKS IF WE DON'T WANT TO, 2044 01:08:58,040 --> 01:08:59,240 I REALIZE WE HAVE A LONG WAY TO 2045 01:08:59,240 --> 01:09:01,640 GO AND I THINK IT'S EXTREMELY 2046 01:09:01,640 --> 01:09:02,960 IMPORTANT AS A GERIATRICIAN THAT 2047 01:09:02,960 --> 01:09:04,480 WE CONTINUE TO POINT OUT HOW 2048 01:09:04,480 --> 01:09:06,360 IMPORTANT IT IS FOR PEOPLE TO DO 2049 01:09:06,360 --> 01:09:08,640 THE BASIC THINGS: VACCINATIONS 2050 01:09:08,640 --> 01:09:08,920 AND MASKS. 2051 01:09:08,920 --> 01:09:14,400 THANK YOU ALL VERY MUCH. 2052 01:09:14,400 --> 01:09:15,160 >> THANK YOU SO MUCH. 2053 01:09:15,160 --> 01:09:19,040 I WANT TO THANK ALL OF OUR 2054 01:09:19,040 --> 01:09:20,120 SPEAKERS, EVERYONE HAD A LOT OF 2055 01:09:20,120 --> 01:09:22,600 VERY HELPFUL INFORMATION TO 2056 01:09:22,600 --> 01:09:23,120 SHARE. 2057 01:09:23,120 --> 01:09:24,760 I WANT TO THANK OUR AUDIENCE. 2058 01:09:24,760 --> 01:09:25,760 WE GOT A LOT OF QUESTIONS. 2059 01:09:25,760 --> 01:09:27,200 WE'LL DO OUR BEST TO GET TO AS 2060 01:09:27,200 --> 01:09:32,880 MANY OF THEM AS WE CAN. 2061 01:09:32,880 --> 01:09:36,120 SO THE FIRST ONE I HAVE, I THINK 2062 01:09:36,120 --> 01:09:38,200 THIS IS PROBABLY FOR DR. BRISS. 2063 01:09:38,200 --> 01:09:40,280 HOW SOON AFTER YOUR LAST BOOSTER 2064 01:09:40,280 --> 01:09:41,760 SHOULD YOU GET THE NEW BOOSTER 2065 01:09:41,760 --> 01:09:44,800 FOR THE MORE RECENT VARIANTS? 2066 01:09:44,800 --> 01:09:48,240 >> ANY TIME THAT YOU'RE AT LEAST 2067 01:09:48,240 --> 01:09:54,600 TWO MONTHS OUT FROM YOUR 2068 01:09:54,600 --> 01:09:56,400 PREVIOUS -- ONCE YOU FINISH YOUR 2069 01:09:56,400 --> 01:09:57,880 PRIMARY SERIES, ANY TIME TWO 2070 01:09:57,880 --> 01:09:59,160 MONTHS AFTER YOUR LAST SHOT, YOU 2071 01:09:59,160 --> 01:10:00,680 CAN GET THE NEW BOOSTER, AND 2072 01:10:00,680 --> 01:10:02,120 THIS APPLIES TO -- THE BOOSTERS 2073 01:10:02,120 --> 01:10:03,840 ARE AVAILABLE FOR EVERYBODY AGES 2074 01:10:03,840 --> 01:10:06,920 12 AND OVER. 2075 01:10:06,920 --> 01:10:07,760 >> THANK YOU. 2076 01:10:07,760 --> 01:10:11,880 AND OUR NEXT QUESTION FOR 2077 01:10:11,880 --> 01:10:12,800 DR. MARQUINE, DOES BEING AWARE 2078 01:10:12,800 --> 01:10:15,120 OF THE NEGATIVE IMPACT OF THE 2079 01:10:15,120 --> 01:10:16,840 PANDEMIC POSITIVELY IMPROVE 2080 01:10:16,840 --> 01:10:19,480 OUTCOMES FOR HISPANIC, LATINO 2081 01:10:19,480 --> 01:10:21,080 AND NON-HISPANIC BLACK 2082 01:10:21,080 --> 01:10:21,560 INDIVIDUALS? 2083 01:10:21,560 --> 01:10:22,840 AND COULD THAT EXPLAIN THE 2084 01:10:22,840 --> 01:10:24,720 INCREASED POSITIVE IMPACTS ON 2085 01:10:24,720 --> 01:10:27,080 THESE TWO GROUPS? 2086 01:10:27,080 --> 01:10:28,200 >> SO VERY GOOD QUESTION. 2087 01:10:28,200 --> 01:10:30,000 I DON'T THINK WE HAVE A STRAIGHT 2088 01:10:30,000 --> 01:10:31,360 ANSWER TO THAT. 2089 01:10:31,360 --> 01:10:33,960 I THINK IT IMPORTANT TO KEEP IN 2090 01:10:33,960 --> 01:10:37,040 MIND THAT OF COURSE THIS IS ALSO 2091 01:10:37,040 --> 01:10:39,000 REPORT DATA SO THIS IS -- THIS 2092 01:10:39,000 --> 01:10:40,320 IS THE PERCEPTION OF PEOPLE, 2093 01:10:40,320 --> 01:10:41,320 WHAT'S HAPPENING TO THEM AND 2094 01:10:41,320 --> 01:10:42,600 WHAT HAS HAPPENED AND HOW THEIR 2095 01:10:42,600 --> 01:10:43,920 LIVES HAVE CHANGED. 2096 01:10:43,920 --> 01:10:46,440 SO I THINK -- I DON'T THINK OUR 2097 01:10:46,440 --> 01:10:47,880 DATA CAN DIRECTLY ANSWER THAT 2098 01:10:47,880 --> 01:10:48,640 QUESTION. 2099 01:10:48,640 --> 01:10:49,920 I DO THINK IT'S IMPORTANT, IT 2100 01:10:49,920 --> 01:10:52,520 IMPORTANT TO RECOGNIZE THAT, 2101 01:10:52,520 --> 01:10:54,200 AGAIN, PEOPLE'S PERCEPTIONS OF 2102 01:10:54,200 --> 01:10:55,360 THE EVENTS THAT ARE HAPPENING IN 2103 01:10:55,360 --> 01:10:56,040 THEIR LIVES. 2104 01:10:56,040 --> 01:10:58,440 WE'RE NOT GOING TO VIDEOTAPE 2105 01:10:58,440 --> 01:11:02,200 THEIR LIVES AND KNOWING, SO IT A 2106 01:11:02,200 --> 01:11:03,000 KEY THING TO CONSIDER AS WE 2107 01:11:03,000 --> 01:11:07,920 THINK ABOUT HOW THIS DATA MIGHT 2108 01:11:07,920 --> 01:11:09,160 INFORM FUTURE POTENTIALLY 2109 01:11:09,160 --> 01:11:10,240 INTERVENTION EFFORTS OR 2110 01:11:10,240 --> 01:11:14,840 PREVENTION EFFORTS FOR FURTHER 2111 01:11:14,840 --> 01:11:15,080 SYMPTOMS. 2112 01:11:15,080 --> 01:11:17,120 >> THANK YOU VERY MUCH. 2113 01:11:17,120 --> 01:11:18,640 I THINK DR. FRONTERA IS WORKING 2114 01:11:18,640 --> 01:11:20,120 ON HER VIDEO, SO I'M GOING TO 2115 01:11:20,120 --> 01:11:22,440 ASK A QUESTION FOR DR. NOBLE. 2116 01:11:22,440 --> 01:11:24,400 DOES THE RESEARCH TEAM BELIEVE 2117 01:11:24,400 --> 01:11:27,920 THAT THE SARS-COV-2 VIRUS 2118 01:11:27,920 --> 01:11:29,120 INCREASES DELIRIUM OR TRIGGERS A 2119 01:11:29,120 --> 01:11:31,320 SEPARATE PATHWAY IN INDIVIDUALS 2120 01:11:31,320 --> 01:11:33,120 WITH DEMENTIA THAT LEADS TO 2121 01:11:33,120 --> 01:11:35,800 DELIRIUM AS A SYMPTOM? 2122 01:11:35,800 --> 01:11:36,760 >> THAT'S A GREAT QUESTION. 2123 01:11:36,760 --> 01:11:38,040 I DON'T THINK WE FULLY 2124 01:11:38,040 --> 01:11:38,400 UNDERSTAND IT. 2125 01:11:38,400 --> 01:11:41,640 I THINK THE WAY THAT WE'VE TRIED 2126 01:11:41,640 --> 01:11:44,280 TO APPROACH IT IS THAT WE SEE 2127 01:11:44,280 --> 01:11:46,520 DELIRIUM AS A COMMON 2128 01:11:46,520 --> 01:11:47,600 MANIFESTATION IN INDIVIDUALS WHO 2129 01:11:47,600 --> 01:11:48,800 HAVE DEMENTIA, NO MATTER THE 2130 01:11:48,800 --> 01:11:49,520 CAUSE OF ILLNESS. 2131 01:11:49,520 --> 01:11:51,480 WE SEE THIS IN PEOPLE WHO HAVE 2132 01:11:51,480 --> 01:11:52,680 URINARY TRACT INFORECASTS, 2133 01:11:52,680 --> 01:11:56,400 PNEUMONIAS OR INFECTIONS, 2134 01:11:56,400 --> 01:11:57,360 PNEUMONIA OR FEVERS FOR OTHER 2135 01:11:57,360 --> 01:11:57,920 REASONS. 2136 01:11:57,920 --> 01:11:59,440 I'M NOT SURE COVID IS 2137 01:11:59,440 --> 01:12:01,000 NECESSARILY DISTINCT FROM THOSE 2138 01:12:01,000 --> 01:12:01,440 OTHER PATHWAYS. 2139 01:12:01,440 --> 01:12:02,280 IT MAY BE. 2140 01:12:02,280 --> 01:12:04,560 THE WAY WE'VE KIND OF 2141 01:12:04,560 --> 01:12:05,680 CONCEPTUALIZED IT, IT SEEMS AS 2142 01:12:05,680 --> 01:12:06,720 THOUGH COVID IS SOMEWHAT 2143 01:12:06,720 --> 01:12:09,080 DISTINCT IN THAT ITS 2144 01:12:09,080 --> 01:12:11,120 INFLAMMATORY STATE IS INTENSELY 2145 01:12:11,120 --> 01:12:13,360 ACTIVE IN ITS IMMEDIATE PHASE, 2146 01:12:13,360 --> 01:12:15,080 PERHAPS TO A GREATER EXTENT THAT 2147 01:12:15,080 --> 01:12:16,920 WE SEE IN THOSE MORE TRADITIONAL 2148 01:12:16,920 --> 01:12:18,440 INFECTIONS WE SEE IN DEMENTIA. 2149 01:12:18,440 --> 01:12:19,760 THAT PROVIDES US A MODEL OF 2150 01:12:19,760 --> 01:12:21,640 THINKING ABOUT IT FROM A 2151 01:12:21,640 --> 01:12:22,160 BIOLOGICAL PATHWAY. 2152 01:12:22,160 --> 01:12:24,480 IT'S ALSO MADE US WONDER, SINCE 2153 01:12:24,480 --> 01:12:26,000 IT IS SUCH A COMMON PROBLEM THAT 2154 01:12:26,000 --> 01:12:27,400 SO MANY PEOPLE HAVE FACED, 2155 01:12:27,400 --> 01:12:28,640 PROBABLY MORE COMMON THAN THINGS 2156 01:12:28,640 --> 01:12:31,000 LIKE URINARY TRACT INFECTIONS OR 2157 01:12:31,000 --> 01:12:32,320 PNEUMONIAS, THAT WE SEE MORE IN 2158 01:12:32,320 --> 01:12:34,800 THE LATER STAGES OF DISEASE, 2159 01:12:34,800 --> 01:12:35,560 COVID PRESENTS AN OPPORTUNITY 2160 01:12:35,560 --> 01:12:38,320 FOR US TO THINK ABOUT HOW 2161 01:12:38,320 --> 01:12:40,280 INFLAMMATION IN THE BODY IMPACTS 2162 01:12:40,280 --> 01:12:41,920 THE EXPRESSION OF DEMENTIA, 2163 01:12:41,920 --> 01:12:43,200 RECOGNIZING THAT OUR TRADITIONAL 2164 01:12:43,200 --> 01:12:45,120 MODELS HAVE BEEN A LOW GRADE 2165 01:12:45,120 --> 01:12:48,040 INFECTION OVER MANY YEARS OF 2166 01:12:48,040 --> 01:12:52,520 TIME OR LOW GRADE INFLATION OF 2167 01:12:52,520 --> 01:12:54,000 INFECTION WE SEE IN PEOPLE THAT 2168 01:12:54,000 --> 01:12:55,480 HAVE DIABETES, OBESITY, SMOKING 2169 01:12:55,480 --> 01:12:57,680 OR SEDENTARY LIFESTYLE, IS COVID 2170 01:12:57,680 --> 01:12:59,280 IN SOME RESPECTS SIMILAR TO 2171 01:12:59,280 --> 01:13:01,560 THAT, BUT IN AN INTENSE 2172 01:13:01,560 --> 01:13:02,920 HIGH DEGREE OF INFLAMMATION OVER 2173 01:13:02,920 --> 01:13:04,360 A BRIEF PERIOD OF TIME RELATIVE 2174 01:13:04,360 --> 01:13:06,880 TO THOSE OTHER TRADITIONAL RISK 2175 01:13:06,880 --> 01:13:08,360 FACTORS WHICH MAY HAVE A 2176 01:13:08,360 --> 01:13:10,040 LOW DEGREE OF INFLAMMATION, TO A 2177 01:13:10,040 --> 01:13:11,760 LOW DEGREE OVER MANY YEARS OF 2178 01:13:11,760 --> 01:13:12,600 TIME, PERHAPS EVEN PRECEDING THE 2179 01:13:12,600 --> 01:13:13,760 FIRST STAGES OF DEMENTIA. 2180 01:13:13,760 --> 01:13:15,240 FROM A CONCEPTUAL STANDPOINT, 2181 01:13:15,240 --> 01:13:16,520 THAT'S REALLY WHAT WE'VE BEEN 2182 01:13:16,520 --> 01:13:17,360 FOCUSED ON. 2183 01:13:17,360 --> 01:13:17,920 I HOPE THAT ANSWERS YOUR 2184 01:13:17,920 --> 01:13:19,240 QUESTION, AND I IMAGINE OTHERS 2185 01:13:19,240 --> 01:13:21,440 ON THE PANEL WILL HAVE SOME 2186 01:13:21,440 --> 01:13:22,560 REFLECTIONS ON THAT TOO. 2187 01:13:22,560 --> 01:13:23,200 >> THANK YOU. 2188 01:13:23,200 --> 01:13:24,480 WE'RE GOING TO MOVE ON TO THE 2189 01:13:24,480 --> 01:13:26,640 NEXT QUESTION FOR DR. FRONTERA. 2190 01:13:26,640 --> 01:13:28,440 WHAT INTERVENTIONS ARE BEING 2191 01:13:28,440 --> 01:13:30,160 TESTED FOR LONG COVID? 2192 01:13:30,160 --> 01:13:33,000 WHICH ARE MOST EFFECTIVE, AND 2193 01:13:33,000 --> 01:13:33,880 SIMILAR -- AND AGO THE SAME 2194 01:13:33,880 --> 01:13:37,840 LINES, WHAT CAN BE DOB DONE TO 2195 01:13:37,840 --> 01:13:38,480 PREVENT LONG COVID? 2196 01:13:38,480 --> 01:13:39,320 >> GOOD QUESTIONS. 2197 01:13:39,320 --> 01:13:40,520 MULTIPART. 2198 01:13:40,520 --> 01:13:46,000 I WILL SAY THAT THE NIH PUT OUT 2199 01:13:46,000 --> 01:13:48,120 A CALL FOR CLINICAL TRIALS LAST 2200 01:13:48,120 --> 01:13:52,120 MAY, AND THE CLINICAL TRIAL 2201 01:13:52,120 --> 01:13:53,320 CENTER SITE, COORDINATING SITE, 2202 01:13:53,320 --> 01:13:57,400 HAS BEEN NAMED, SO WE ARE 2203 01:13:57,400 --> 01:13:59,040 ANTICIPATING THAT CLINICAL 2204 01:13:59,040 --> 01:14:00,560 TRIALS WILL START UP SHORTLY, 2205 01:14:00,560 --> 01:14:03,400 AND I CAN ONLY SURMISE WHAT 2206 01:14:03,400 --> 01:14:08,120 MIGHT BE STUDIED BECAUSE I DON'T 2207 01:14:08,120 --> 01:14:09,760 THINK AWARDS HAVE BEEN ANNOUNCED 2208 01:14:09,760 --> 01:14:10,040 YET. 2209 01:14:10,040 --> 01:14:11,440 SO CURRENTLY THINGS WE'RE USING 2210 01:14:11,440 --> 01:14:15,120 THERAPEUTICALLY ARE REALLY 2211 01:14:15,120 --> 01:14:16,320 SYMPTOM-BASED, AND AT LEAST OUR 2212 01:14:16,320 --> 01:14:18,000 DATA, WHICH IS ONLY 122 PATIENTS 2213 01:14:18,000 --> 01:14:19,920 SO IT'S A SMALL COHORT, SUGGESTS 2214 01:14:19,920 --> 01:14:21,600 THAT THEY'RE STILL PRETTY 2215 01:14:21,600 --> 01:14:23,120 EFFECTIVE, EVEN WHAT CL 2216 01:14:23,120 --> 01:14:24,840 CLINICIANS ARE DOING BASED ON 2217 01:14:24,840 --> 01:14:25,920 SYMPTOMS AT THIS TIME. 2218 01:14:25,920 --> 01:14:27,120 CERTAINLY FOR POST COVID 2219 01:14:27,120 --> 01:14:28,400 HEADACHE, WE OFTEN EXTRAPOLATE 2220 01:14:28,400 --> 01:14:30,240 FOR WHAT WE DO FOR 2221 01:14:30,240 --> 01:14:31,040 POST-TRAUMATIC BRAIN INJURY 2222 01:14:31,040 --> 01:14:32,520 HEADACHE AND IT SEEMS TO BE 2223 01:14:32,520 --> 01:14:33,640 EFFECTIVE BASED ON SOME STUDIES 2224 01:14:33,640 --> 01:14:37,760 THAT ARE OUT THERE USING 2225 01:14:37,760 --> 01:14:39,520 AMITRIPTYLINE OR NORTRIPTYLINE, 2226 01:14:39,520 --> 01:14:40,680 WHICH MAY NOT BE OPTIONS FOR 2227 01:14:40,680 --> 01:14:42,600 OLDER PEOPLE, BUT CERTAINLY DO 2228 01:14:42,600 --> 01:14:46,120 SEEM TO HELP YOUNGER FOLKS WITH 2229 01:14:46,120 --> 01:14:48,800 POST COVID COGNITIVE ISSUES. 2230 01:14:48,800 --> 01:14:52,480 DR. MORLEY MENTIONED SOME 2231 01:14:52,480 --> 01:14:53,160 POTENTIAL COGNITIVE EXERCISES 2232 01:14:53,160 --> 01:14:56,000 THAT FOLKS MIGHT USE. 2233 01:14:56,000 --> 01:14:57,720 AGAIN, VERY LIMITED DATA IN THE 2234 01:14:57,720 --> 01:14:58,400 CONTEXT OF COVID FOR THIS. 2235 01:14:58,400 --> 01:14:59,600 I THINK THERE'S A LOT OF 2236 01:14:59,600 --> 01:15:02,440 INTEREST, IF I'M GOING TO 2237 01:15:02,440 --> 01:15:03,960 SPECULATE, I THINK THE FIRST 2238 01:15:03,960 --> 01:15:05,400 TRIAL MIGHT BE SOMETHING LOOKING 2239 01:15:05,400 --> 01:15:09,880 AT PAXLOVID IN TERMS OF THIS 2240 01:15:09,880 --> 01:15:11,640 CONCEPT OF LOOKING AT VIRAL 2241 01:15:11,640 --> 01:15:13,760 RESERVOIRS, AND ELIMINATING 2242 01:15:13,760 --> 01:15:15,280 VIRAL RESERVOIRS AS THEY MAY 2243 01:15:15,280 --> 01:15:17,000 CONTRIBUTE TO CHRONIC 2244 01:15:17,000 --> 01:15:18,200 INFLAMMATION AND POST COVID 2245 01:15:18,200 --> 01:15:18,520 SYMPTOMS. 2246 01:15:18,520 --> 01:15:19,600 BUT AGAIN, THAT'S JUST MY GUESS, 2247 01:15:19,600 --> 01:15:20,920 AND I DON'T KNOW WHICH STUDIES 2248 01:15:20,920 --> 01:15:22,880 ARE GOING TO BE STARTED SOON, 2249 01:15:22,880 --> 01:15:24,360 BUT THE GOOD NEWS IS THERE'S A 2250 01:15:24,360 --> 01:15:27,400 LOT OF MONEY PUT TOWARDS IT BY 2251 01:15:27,400 --> 01:15:29,920 NIH, AND I THINK WE'LL START TO 2252 01:15:29,920 --> 01:15:31,840 HAVE ANSWERS ROLLING IN, WHICH 2253 01:15:31,840 --> 01:15:32,760 PEOPLE ARE DESPERATELY WAITING 2254 01:15:32,760 --> 01:15:32,920 FOR. 2255 01:15:32,920 --> 01:15:34,400 >> THANK YOU SO MUCH. 2256 01:15:34,400 --> 01:15:36,440 JUST AS A FOLLOW-UP, I KNOW YOU 2257 01:15:36,440 --> 01:15:37,320 MENTIONED THE TREATMENT MIGHT 2258 01:15:37,320 --> 01:15:38,760 NOT BE GOOD FOR OLDER ADULTS. 2259 01:15:38,760 --> 01:15:40,440 COULD YOU ELABORATE JUST A BIT 2260 01:15:40,440 --> 01:15:40,680 ON THAT? 2261 01:15:40,680 --> 01:15:45,520 >> YEAH, I MEAN, SO THE TRY 2262 01:15:45,520 --> 01:15:47,480 TRI-CYCLIC DRUGS, REALLY AN OLD 2263 01:15:47,480 --> 01:15:48,720 GROUP OF DRUGS TYPICALLY USED 2264 01:15:48,720 --> 01:15:51,200 FOR DEPRESSION, ARE REALLY GREAT 2265 01:15:51,200 --> 01:15:53,880 FOR MIGRAINE-TYPE HEADACHES AND 2266 01:15:53,880 --> 01:15:54,920 POST-TRAUMATIC BRAIN INJURY 2267 01:15:54,920 --> 01:15:55,760 HEADACHES, AND THERE'S A 2268 01:15:55,760 --> 01:15:57,200 LITERATURE USING THEM FOR POST 2269 01:15:57,200 --> 01:16:00,160 COVID HEADACHES, BUT THEY CAN 2270 01:16:00,160 --> 01:16:01,600 HAVE THIS SIDE EFFECT OF 2271 01:16:01,600 --> 01:16:03,800 ACTUALLY INCREASING CONFUSION, 2272 01:16:03,800 --> 01:16:06,720 URINARY RETENTION, THEY CAN 2273 01:16:06,720 --> 01:16:09,040 CAUSE HEART EKG SIDE EFFECTS, 2274 01:16:09,040 --> 01:16:10,800 WHICH IS PARTICULARLY NOTABLE IN 2275 01:16:10,800 --> 01:16:12,360 OLDER FOLKS. 2276 01:16:12,360 --> 01:16:15,480 SO WE MAY NOT BE ABLE TO 2277 01:16:15,480 --> 01:16:16,120 NECESSARILY EXTRAPOLATE ALL THE 2278 01:16:16,120 --> 01:16:19,000 DATA WE HAVE IN POST COVID 2279 01:16:19,000 --> 01:16:20,520 POPULATIONS TO OLDER 2280 01:16:20,520 --> 01:16:20,840 POPULATIONS. 2281 01:16:20,840 --> 01:16:22,280 >> SO VERY IMPORTANT TO KNOW, 2282 01:16:22,280 --> 01:16:23,920 AND ALSO I'LL JUST PUT A PLUG IN 2283 01:16:23,920 --> 01:16:25,320 FOR THAT IS WHY IT'S VERY 2284 01:16:25,320 --> 01:16:27,080 IMPORTANT TO HAVE OLDER ADULTS 2285 01:16:27,080 --> 01:16:29,360 PARTICIPATE IN CLINICAL TRIALS. 2286 01:16:29,360 --> 01:16:29,920 OKAY. 2287 01:16:29,920 --> 01:16:32,440 MOVING ON TO THE NEXT 2288 01:16:32,440 --> 01:16:32,760 QUESTION -- 2289 01:16:32,760 --> 01:16:33,960 >> CAN I JUST ADD ONE THING? 2290 01:16:33,960 --> 01:16:36,400 THE LITERATURE HAS SUGGESTED 2291 01:16:36,400 --> 01:16:38,040 THAT VACCINES DECREASE THE 2292 01:16:38,040 --> 01:16:39,560 AMOUNT OF LONG COVID. 2293 01:16:39,560 --> 01:16:41,960 IT'S NOT ABSOLUTE, BUT THERE IS 2294 01:16:41,960 --> 01:16:44,720 ENOUGH DATA THERE. 2295 01:16:44,720 --> 01:16:45,600 THERE HAS BEEN VERY LITTLE DATA 2296 01:16:45,600 --> 01:16:47,880 OR NONE THAT I KNOW OF LOOKING 2297 01:16:47,880 --> 01:16:50,000 AT PEOPLE WHO'VE HAD COVID, GET 2298 01:16:50,000 --> 01:16:52,280 LONG COVID, GETTING VACCINES, 2299 01:16:52,280 --> 01:16:53,880 BUT IT ACTUALLY MAKES A LOT OF 2300 01:16:53,880 --> 01:16:55,520 SENSE THAT YOU REALLY WANT TO 2301 01:16:55,520 --> 01:16:57,480 TRY AND GET RID OF THE COVID 2302 01:16:57,480 --> 01:17:00,360 THAT'S LEFT IN THE BODY CAUSING 2303 01:17:00,360 --> 01:17:02,880 LONG COVID, AND IT SEEMS TO ME 2304 01:17:02,880 --> 01:17:05,320 THAT THE THINGS THAT WE DO 2305 01:17:05,320 --> 01:17:07,120 REALLY BADLY AT THE MOMENT ARE 2306 01:17:07,120 --> 01:17:09,600 PAYING ATTENTION TO VACCINES AND 2307 01:17:09,600 --> 01:17:12,560 MAKING SURE THAT EVERYBODY GETS 2308 01:17:12,560 --> 01:17:12,840 VACCINATED. 2309 01:17:12,840 --> 01:17:14,640 SO SAME THING WITH FLU, IF YOU 2310 01:17:14,640 --> 01:17:17,040 DON'T GET IT FOR YEARS AND 2311 01:17:17,040 --> 01:17:21,080 PEOPLE DON'T GET FLU, OR THE FU 2312 01:17:21,080 --> 01:17:22,640 VACCINE DOESN'T WORK WELL, WE 2313 01:17:22,640 --> 01:17:23,280 HAVE TREMENDOUS PROBLEMS WITH 2314 01:17:23,280 --> 01:17:23,960 OLDER PEOPLE. 2315 01:17:23,960 --> 01:17:25,360 I THINK WE HAVE TO PAY MORE 2316 01:17:25,360 --> 01:17:27,880 ATTENTION TO THOSE, AND IT 2317 01:17:27,880 --> 01:17:29,320 TERRIFIES ME WHERE I HEAR LARGE 2318 01:17:29,320 --> 01:17:30,640 AMOUNT OF MONEY BEING GIVEN OUT 2319 01:17:30,640 --> 01:17:32,600 TO STUDY THINGS. 2320 01:17:32,600 --> 01:17:34,160 I RECOGNIZE THAT MEANS IT WILL 2321 01:17:34,160 --> 01:17:36,560 BE ALL UNIQUE, WONDERFUL 2322 01:17:36,560 --> 01:17:37,760 MARVELOUS THINGS WHICH I SPENT 2323 01:17:37,760 --> 01:17:42,160 MY LIFE STUDYING AS WELL, AND WE 2324 01:17:42,160 --> 01:17:43,520 WON'T PUT NEARLY ENOUGH MONEY 2325 01:17:43,520 --> 01:17:44,520 INTO THE SIMPLE THINGS. 2326 01:17:44,520 --> 01:17:45,720 JUST A THOUGHT FOR THE PEOPLE 2327 01:17:45,720 --> 01:17:46,840 OUT THERE WHO MIGHT BE DOING 2328 01:17:46,840 --> 01:17:47,720 THIS. 2329 01:17:47,720 --> 01:17:50,440 >> SO THE TAKE-HOME MESSAGE IS 2330 01:17:50,440 --> 01:17:52,040 VACCINES IN THIS CONTEXT ARE 2331 01:17:52,040 --> 01:17:54,640 ALMOST ALWAYS THE RIGHT ANSWER. 2332 01:17:54,640 --> 01:17:54,880 OVER. 2333 01:17:54,880 --> 01:17:56,480 >> THANK YOU, PETER. 2334 01:17:56,480 --> 01:18:00,080 I WISH CDC WOULD SAY IT A LITTLE 2335 01:18:00,080 --> 01:18:00,320 LOUDER. 2336 01:18:00,320 --> 01:18:01,280 >> OKAY. 2337 01:18:01,280 --> 01:18:03,840 NEXT QUESTION FOR DR. BRISS. 2338 01:18:03,840 --> 01:18:05,360 RELATED TO SOME OF THE TOPICS 2339 01:18:05,360 --> 01:18:07,120 THAT YOU COVERED. 2340 01:18:07,120 --> 01:18:08,640 THIS PERSON SAID, WITHOUT HAVING 2341 01:18:08,640 --> 01:18:11,000 A CRYSTAL BALL, WHAT TYPES OF 2342 01:18:11,000 --> 01:18:13,080 ADVERSE HEALTH OUTCOMES DO YOU 2343 01:18:13,080 --> 01:18:15,200 ANTICIPATE FOR OLDER ADULTS AS A 2344 01:18:15,200 --> 01:18:17,200 RESULT OF THE DECLINE IN 2345 01:18:17,200 --> 01:18:18,000 HEALTHCARE USAGE DURING THE 2346 01:18:18,000 --> 01:18:22,200 PANDEMIC? 2347 01:18:22,200 --> 01:18:23,600 >> THAT'S A GREAT QUESTION. 2348 01:18:23,600 --> 01:18:27,240 WE DON'T KNOW ABOUT OUTCOMES 2349 01:18:27,240 --> 01:18:33,840 YET, BUT WE DO KNOW THAT THERE 2350 01:18:33,840 --> 01:18:35,880 HAVE BEEN GAPS IN CARE, IN 2351 01:18:35,880 --> 01:18:36,920 HYPERTENSION MANAGEMENT AND 2352 01:18:36,920 --> 01:18:41,160 DIABETES MANAGEMENT, AND CANCER 2353 01:18:41,160 --> 01:18:43,360 SCREENING AND A LONG LIST OF 2354 01:18:43,360 --> 01:18:47,160 OTHER THINGS. 2355 01:18:47,160 --> 01:18:49,160 AND SO THE BOTTOM LINE IS THAT 2356 01:18:49,160 --> 01:18:50,440 WE HAVE A LOT OF CATCHING UP TO 2357 01:18:50,440 --> 01:18:52,240 DO AND IT'S TIME TO GET BUSY. 2358 01:18:52,240 --> 01:18:54,720 >> THANK YOU SO MUCH. 2359 01:18:54,720 --> 01:19:00,720 NEXT QUESTION FOR 2360 01:19:00,720 --> 01:19:01,760 DR. MARTINIQUE. 2361 01:19:01,760 --> 01:19:04,360 OF WHAT INTERVENTIONS HAVE BEEN 2362 01:19:04,360 --> 01:19:05,280 TAKEN TO ALLEVIATE THE EFFECT OF 2363 01:19:05,280 --> 01:19:07,080 THE PANDEMIC ACROSS OLDER ADULT 2364 01:19:07,080 --> 01:19:10,240 GROUPS AND PARTICULARLY AMONG 2365 01:19:10,240 --> 01:19:11,120 UNDERSERVED GROUPS? 2366 01:19:11,120 --> 01:19:14,080 >> SO I THINK IT DEPENDS ON THE 2367 01:19:14,080 --> 01:19:15,280 TYPE OF INTERVENTION THAT PEOPLE 2368 01:19:15,280 --> 01:19:16,120 ARE THINKING ABOUT. 2369 01:19:16,120 --> 01:19:19,120 SO I WOULD SAY SOME OF THE 2370 01:19:19,120 --> 01:19:22,720 BIGGEST ONES, I WOULD SAY 2371 01:19:22,720 --> 01:19:25,360 MENTIONED BEFORE MINIMIZE THE 2372 01:19:25,360 --> 01:19:26,720 NEGATIVE IMPACT OF THE PANDEMIC 2373 01:19:26,720 --> 01:19:28,200 IS HAVING VACCINES AVAILABLE, BY 2374 01:19:28,200 --> 01:19:29,200 HAVING THOSE ACCESSIBLE TO 2375 01:19:29,200 --> 01:19:29,720 PEOPLE. 2376 01:19:29,720 --> 01:19:31,680 LIKE IF WE ARE ABLE TO GET 2377 01:19:31,680 --> 01:19:32,880 VACCINATED, UNDERSTANDING THAT 2378 01:19:32,880 --> 01:19:36,640 MASKS ARE HELPFUL, THAT WE'RE 2379 01:19:36,640 --> 01:19:38,080 NOT THAT SURE WHEN ALL OF THIS 2380 01:19:38,080 --> 01:19:39,880 BEGAN, YOU MIGHT RECALL, RIGHT, 2381 01:19:39,880 --> 01:19:41,000 THIS WAS NOT PUT FORWARD IN THAT 2382 01:19:41,000 --> 01:19:41,320 WAY. 2383 01:19:41,320 --> 01:19:42,960 THOSE ARE THE TYPE OF 2384 01:19:42,960 --> 01:19:43,840 INTERVENTIONS AT A LOCAL LEVEL 2385 01:19:43,840 --> 01:19:51,200 THAT COULD HELPLESS PEOPLE GET 2386 01:19:51,200 --> 01:19:53,240 SICK, HELP LESS PEOPLE GET 2387 01:19:53,240 --> 01:19:54,280 SERIOUSLY SICK, AND BE ABLE TO 2388 01:19:54,280 --> 01:19:56,600 ENIMAIJ IN 2389 01:19:56,600 --> 01:19:57,880 ENGAGE IN A DIFFERENT WAY AND 2390 01:19:57,880 --> 01:19:59,040 LEAD OUR LIVES IN THE WAYS WE 2391 01:19:59,040 --> 01:20:00,600 WOULD LIKE TO. 2392 01:20:00,600 --> 01:20:01,800 SO THAT'S WHAT I WOULD SAY IS 2393 01:20:01,800 --> 01:20:03,440 KIND OF ONE BROAD SENSE OF 2394 01:20:03,440 --> 01:20:05,600 INTERVENTIONS. 2395 01:20:05,600 --> 01:20:06,720 I THINK THERE'S BEEN A HOST OF 2396 01:20:06,720 --> 01:20:09,280 DIFFERENT THINGS THAT PEOPLE 2397 01:20:09,280 --> 01:20:11,560 HAVE TRIED AT A SMALL LEVEL AS 2398 01:20:11,560 --> 01:20:12,640 WELL IN DIFFERENT GROUPS. 2399 01:20:12,640 --> 01:20:14,080 OF COURSE I'M NOT AWARE OF 2400 01:20:14,080 --> 01:20:15,160 ABSOLUTELY ALL OF THEM, BUT 2401 01:20:15,160 --> 01:20:18,600 THERE ARE PROGRAMS, FOR EXAMPLE, 2402 01:20:18,600 --> 01:20:20,080 I KNOW MY INSTITUTION AND TRYING 2403 01:20:20,080 --> 01:20:21,320 TO CONNECT OLDER ADULTS IN 2404 01:20:21,320 --> 01:20:23,360 DIFFERENT WAYS, HAVING PROGRAMS 2405 01:20:23,360 --> 01:20:26,200 TO DIGITALIZE THE POPULATION AND 2406 01:20:26,200 --> 01:20:27,200 THE OLDER ADULT POPULATION TO 2407 01:20:27,200 --> 01:20:31,000 HAVE THEM GET ACCESS TO NO THE 2408 01:20:31,000 --> 01:20:32,640 ONLY CONNECT SOCIALLY WITH OTHER 2409 01:20:32,640 --> 01:20:33,560 PEOPLE, BUT ACCESS TO CARE AND 2410 01:20:33,560 --> 01:20:34,000 SO FORTH. 2411 01:20:34,000 --> 01:20:35,720 SO THOSE ARE JUST SOME OF THE 2412 01:20:35,720 --> 01:20:37,040 FEW THAT COME TO MIND AT THIS 2413 01:20:37,040 --> 01:20:39,240 POINT, AND I KNOW SMALLER TYPES 2414 01:20:39,240 --> 01:20:40,440 OF INTERVENTIONS AS WELL. 2415 01:20:40,440 --> 01:20:42,040 BUT I'M SURE OTHERS ON THE PANEL 2416 01:20:42,040 --> 01:20:42,960 MIGHT HAVE SOME OTHER THINGS 2417 01:20:42,960 --> 01:20:44,480 THEY MIGHT WANT TO ADD AS WELL. 2418 01:20:44,480 --> 01:20:46,120 >> I DID NOTICE IN YOUR 2419 01:20:46,120 --> 01:20:47,840 PRESENTATION THAT ONE OF THE 2420 01:20:47,840 --> 01:20:49,640 POSITIVE IMPACTS THAT YOU 2421 01:20:49,640 --> 01:20:52,520 COMMENTED ON AND THAT YOU HEARD 2422 01:20:52,520 --> 01:20:54,640 FROM YOUR RESPONDENTS WAS THAT A 2423 01:20:54,640 --> 01:20:57,120 LOT OF THEM WERE DOING VOLUNTEER 2424 01:20:57,120 --> 01:21:00,720 WORK IN THEIR COMMUNITIES. 2425 01:21:00,720 --> 01:21:02,680 SO I KNOW THERE ARE EFFORTS FROM 2426 01:21:02,680 --> 01:21:03,560 PEOPLE WITHIN THE COMMUNITY TO 2427 01:21:03,560 --> 01:21:05,880 HELP WITH EDUCATION AND HELPING 2428 01:21:05,880 --> 01:21:07,600 TO EXPLAIN WHAT THE VACCINE DOES 2429 01:21:07,600 --> 01:21:11,960 AND WHAT IT DOESN'T DO HOW IT 2430 01:21:11,960 --> 01:21:13,200 CAN HELP TO TRY TO RAISE 2431 01:21:13,200 --> 01:21:16,480 AWARENESS OF THAT. 2432 01:21:16,480 --> 01:21:18,000 >> THAT'S A VERY GOOD POINT. 2433 01:21:18,000 --> 01:21:19,600 I THINK IN DIFFERENT COUNTRIES 2434 01:21:19,600 --> 01:21:21,000 AS WELL IN DIFFERENT WAYS, SO I 2435 01:21:21,000 --> 01:21:23,720 CAN SPEAK TO SOME OF THE OTHER 2436 01:21:23,720 --> 01:21:26,000 MEDIA I SEE IN LATIN AMERICAN 2437 01:21:26,000 --> 01:21:27,880 COUNTRIES FROM THESE 2438 01:21:27,880 --> 01:21:28,640 INTERVENTIONS AT A GLOBAL LEVEL 2439 01:21:28,640 --> 01:21:30,040 OF LIKE LET'S GET OUTSIDE IN 2440 01:21:30,040 --> 01:21:32,360 OPEN SPACES WITH NATURE. 2441 01:21:32,360 --> 01:21:33,480 ALL OF THESE THINGS, PEOPLE 2442 01:21:33,480 --> 01:21:35,560 DIDN'T USED TO DO AS MUCH AND 2443 01:21:35,560 --> 01:21:37,000 RECOGNIZING THE POSITIVE IMPACT 2444 01:21:37,000 --> 01:21:37,520 OF THAT. 2445 01:21:37,520 --> 01:21:39,120 AND THAT SENSE OF WE'RE ALL IN 2446 01:21:39,120 --> 01:21:39,960 THIS TOGETHER, WE'RE ALL LIVING 2447 01:21:39,960 --> 01:21:41,680 THROUGH THIS HISTORICAL TIME, 2448 01:21:41,680 --> 01:21:42,360 RIGHT? 2449 01:21:42,360 --> 01:21:45,200 WE'RE IN IT TOGETHER. 2450 01:21:45,200 --> 01:21:47,200 SO HOW CAN WE SUPPORT EACH OTHER 2451 01:21:47,200 --> 01:21:47,640 TO MOVE FORWARD? 2452 01:21:47,640 --> 01:21:49,360 I THINK JUST HAVING THAT MESSAGE 2453 01:21:49,360 --> 01:21:50,480 CUT ACROSS SEGMENT OF THE 2454 01:21:50,480 --> 01:21:52,360 POPULATION CAN BE VERY POWERFUL. 2455 01:21:52,360 --> 01:21:55,160 I'VE SEEN THAT HAPPEN IN OTHER 2456 01:21:55,160 --> 01:21:56,120 SPACES. 2457 01:21:56,120 --> 01:21:58,320 MAYBE NOT SO MUCH HERE, MAYBE IN 2458 01:21:58,320 --> 01:22:00,800 THE U.S., BUT MAYBE -- IN SOME 2459 01:22:00,800 --> 01:22:02,440 GROUPS, BUT THAT CAN BE VERY 2460 01:22:02,440 --> 01:22:05,280 POWERFUL AS WELL, THAT SENSE 2461 01:22:05,280 --> 01:22:05,480 OF -- 2462 01:22:05,480 --> 01:22:07,800 >> I THINK WE ALSO NEED TO PUSH 2463 01:22:07,800 --> 01:22:09,120 THE OTHER PART OF PREVENTION, 2464 01:22:09,120 --> 01:22:10,120 WHICH IS MASKS. 2465 01:22:10,120 --> 01:22:12,000 YOU KNOW, THIS IS NOT OVER. 2466 01:22:12,000 --> 01:22:14,320 IF WE WANT TO KEEP ON GETTING 2467 01:22:14,320 --> 01:22:15,640 IT, IT'S GOING TO KEEP ON DOING 2468 01:22:15,640 --> 01:22:17,440 WHAT FLU DOES, WHICH IS CHANGE 2469 01:22:17,440 --> 01:22:18,600 ITSELF A LITTLE BIT. 2470 01:22:18,600 --> 01:22:21,240 WE'VE GOT TO BE MUCH MORE AWARE 2471 01:22:21,240 --> 01:22:23,640 THAT PEOPLE NEED THE MASKS AT 2472 01:22:23,640 --> 01:22:24,720 LEAST WHEN THEY'RE OUT IN 2473 01:22:24,720 --> 01:22:26,600 PUBLIC, INDOORS, AND IF PEOPLE 2474 01:22:26,600 --> 01:22:28,520 DON'T WANT TO DO THAT, IT'S NOT 2475 01:22:28,520 --> 01:22:29,280 GOING TO GET BETTER. 2476 01:22:29,280 --> 01:22:31,320 SO WE CAN BE LIKE SINGAPORE, 2477 01:22:31,320 --> 01:22:32,920 WHICH REALLY KNOWS HOW TO DO 2478 01:22:32,920 --> 01:22:36,360 THINGS LIKE THIS, SO LIKE THE 2479 01:22:36,360 --> 01:22:37,760 UNITED STATES OR BRAZIL. 2480 01:22:37,760 --> 01:22:38,840 BRAZIL IS ACTUALLY WORSE THAN 2481 01:22:38,840 --> 01:22:39,360 THE UNITED STATES. 2482 01:22:39,360 --> 01:22:40,600 I'VE BEEN THERE A NUMBER OF 2483 01:22:40,600 --> 01:22:42,160 TIMES, AND THEY HAVE LITTLE 2484 01:22:42,160 --> 01:22:44,360 INTEREST IN DOING ANY OF THIS AS 2485 01:22:44,360 --> 01:22:46,200 WE HAVE IN THE STATES, I THINK. 2486 01:22:46,200 --> 01:22:48,800 BUT WE REALLY DO NEED TO PUSH 2487 01:22:48,800 --> 01:22:50,680 THE POSSIBILITY THAT WE SHOULD 2488 01:22:50,680 --> 01:22:52,880 KEEP ON PREVENTING UNTIL THE 2489 01:22:52,880 --> 01:22:53,880 AMOUNT IN THE COMMUNITY IS VERY 2490 01:22:53,880 --> 01:22:54,200 LOW. 2491 01:22:54,200 --> 01:22:56,640 AT THE MOMENT, WE'RE NOWHERE 2492 01:22:56,640 --> 01:22:58,200 CLOSE TO HAVING A LOW ENOUGH 2493 01:22:58,200 --> 01:23:00,360 AMOUNT TO SAY THAT PREVENTION IS 2494 01:23:00,360 --> 01:23:02,440 NOT WORTHWHILE DOING, AT LEAST 2495 01:23:02,440 --> 01:23:05,520 IN MY, I THINK, SCIENTIFIC 2496 01:23:05,520 --> 01:23:07,040 OPINION BECAUSE THAT'S WHAT THE 2497 01:23:07,040 --> 01:23:13,960 SCIENCE SAYS AS WELL. 2498 01:23:13,960 --> 01:23:16,680 >> WE HAVE A QUESTION ASKED FOR 2499 01:23:16,680 --> 01:23:17,600 DR. FRONTERA BUT DR. NOBLE IF 2500 01:23:17,600 --> 01:23:18,880 YOU WOULD ALSO ANSWER. 2501 01:23:18,880 --> 01:23:20,560 CAN COVID CAUSE DEMENTIA 2502 01:23:20,560 --> 01:23:21,800 OUTRIGHT, OR IS IT MORE THE CASE 2503 01:23:21,800 --> 01:23:23,480 THAT IT CAUSES THE EXACERBATION 2504 01:23:23,480 --> 01:23:27,040 OF DEMENTIA? 2505 01:23:27,040 --> 01:23:28,880 >> SO YEAH, I WANT TO SAY WE 2506 01:23:28,880 --> 01:23:29,440 DEFINITELY DO NOT KNOW THE 2507 01:23:29,440 --> 01:23:32,680 ANSWER TO THAT YET, SO I WOULD, 2508 01:23:32,680 --> 01:23:34,120 YOU KNOW, NOT WANT PEOPLE TO 2509 01:23:34,120 --> 01:23:35,560 BECOME OVERLY ALARMED. 2510 01:23:35,560 --> 01:23:38,160 IT CERTAINLY AN AREA OF 2511 01:23:38,160 --> 01:23:40,360 RESEARCH, BUT I WOULD NOT SAY AT 2512 01:23:40,360 --> 01:23:42,480 THIS POINT THAT COVID OVERTLY 2513 01:23:42,480 --> 01:23:43,880 CAUSED DEMENTIA. 2514 01:23:43,880 --> 01:23:45,960 I THINK THAT CERTAINLY A LOT OF 2515 01:23:45,960 --> 01:23:48,320 US ARE LOOKING INTO IT, BUT I 2516 01:23:48,320 --> 01:23:51,920 WOULD HESITATE TO MAKE THAT 2517 01:23:51,920 --> 01:23:52,640 PROCLAMATION. 2518 01:23:52,640 --> 01:23:57,360 AND I'LL LET JAMIE ANSWER THE 2519 01:23:57,360 --> 01:23:59,880 PART ABOUT WORSENING DEMENTIA. 2520 01:23:59,880 --> 01:24:01,560 >> IN MY CLINICAL PRACTICE, I'VE 2521 01:24:01,560 --> 01:24:03,200 NOT ONLY SEEN PEOPLE GET WORSE 2522 01:24:03,200 --> 01:24:04,400 AFTER HAVING COVID BUT I'VE 2523 01:24:04,400 --> 01:24:05,480 ACTUALLY SEEN PEOPLE BOUNCE BACK 2524 01:24:05,480 --> 01:24:06,920 WITH NOT REALLY AN APPRECIABLE 2525 01:24:06,920 --> 01:24:09,360 CHANGE IN THEIR OVERALL 2526 01:24:09,360 --> 01:24:10,240 TRAJECTORY WHICH WAS HAPPENING 2527 01:24:10,240 --> 01:24:10,920 IN THE BACKGROUND. 2528 01:24:10,920 --> 01:24:12,320 IT FOR THIS REASON THAT WE 2529 01:24:12,320 --> 01:24:14,320 REALLY NEED TO WORK WITH THE 2530 01:24:14,320 --> 01:24:15,600 LARGEST COHORTS POSSIBLE TO 2531 01:24:15,600 --> 01:24:16,240 UNDERSTAND WHAT ARE THE 2532 01:24:16,240 --> 01:24:17,200 DIFFERENCES BETWEEN THOSE TWO 2533 01:24:17,200 --> 01:24:18,160 PEOPLE WHO SEEM TO HAVE THE SAME 2534 01:24:18,160 --> 01:24:20,560 DISEASE BUT HAVE VERY DIFFERENT 2535 01:24:20,560 --> 01:24:20,880 TRAJECTORIES? 2536 01:24:20,880 --> 01:24:22,120 TO THE POINT OF WHETHER OR NOT 2537 01:24:22,120 --> 01:24:27,400 IT CAN CAUSE IT, WE'VE ACTUALLY 2538 01:24:27,400 --> 01:24:29,320 UNDERTAKEN AT OUR CENTER A 2539 01:24:29,320 --> 01:24:30,080 NEUROPATHOLOGICAL STUDY OF 2540 01:24:30,080 --> 01:24:31,440 PEOPLE WHO INITIALLY PRESENTED 2541 01:24:31,440 --> 01:24:32,560 WITH COVID AND CAME TO PASS 2542 01:24:32,560 --> 01:24:34,440 BECAUSE OF THEIR ILLNESS. 2543 01:24:34,440 --> 01:24:36,320 AND FOR THE MOST PART, THE MAIN 2544 01:24:36,320 --> 01:24:38,400 CHANGES THAT ARE SEEN WITH UNDER 2545 01:24:38,400 --> 01:24:39,680 THE MICROSCOPE DO NOT SUGGEST 2546 01:24:39,680 --> 01:24:41,400 THAT THERE'S A STRONG VIRAL 2547 01:24:41,400 --> 01:24:42,960 INFECTION OF THE BRAIN CELLS, 2548 01:24:42,960 --> 01:24:45,160 BUT MAYBE NOR INFLAMMATION IN 2549 01:24:45,160 --> 01:24:46,880 THE SMALL VESTING STROKES THAT 2550 01:24:46,880 --> 01:24:47,760 WE'VE COME TO RECOGNIZE. 2551 01:24:47,760 --> 01:24:49,360 SO IN AND OF ITSELF, BRAIN 2552 01:24:49,360 --> 01:24:50,480 CHANGES ARE NOT THAT OBVIOUS 2553 01:24:50,480 --> 01:24:53,000 WITH THE EXCEPTION OF MAYBE SOME 2554 01:24:53,000 --> 01:24:53,560 MICROVASCULAR CHANGES. 2555 01:24:53,560 --> 01:24:55,160 WE'RE NOT SEEING AS THOUGH 2556 01:24:55,160 --> 01:24:56,840 SOMEBODY HAS A BLOSSOMING OF 2557 01:24:56,840 --> 01:24:58,000 ALZHEIMER'S CHANGES UNDER THE 2558 01:24:58,000 --> 01:24:59,160 MICROSCOPE, AND TO SOME EXTENT, 2559 01:24:59,160 --> 01:25:01,160 THAT REFLECTS WHAT WE KNOW OF 2560 01:25:01,160 --> 01:25:01,880 ALZHEIMER'S DISEASE IN THAT IT 2561 01:25:01,880 --> 01:25:03,440 TAKES YEARS FOR PEOPLE TO 2562 01:25:03,440 --> 01:25:05,360 DEVELOP CHANGES MICROSCOPICALLY 2563 01:25:05,360 --> 01:25:06,200 OF ALZHEIMER'S DISEASE THAT 2564 01:25:06,200 --> 01:25:07,240 EVENTUALLY LEAD TO THE CLINICAL 2565 01:25:07,240 --> 01:25:08,520 SYNDROME THAT WE SEE OF FOR 2566 01:25:08,520 --> 01:25:09,960 GETTING OR OTHER COGNITIVE 2567 01:25:09,960 --> 01:25:10,280 IMPAIRMENT. 2568 01:25:10,280 --> 01:25:11,480 SO IT'S A GREAT QUESTION. 2569 01:25:11,480 --> 01:25:14,560 WE DON'T HAVE A FULL ANSWER BUT 2570 01:25:14,560 --> 01:25:16,080 I AGREE WITH DR. FRONTERA. 2571 01:25:16,080 --> 01:25:19,720 >> ALONG THOSE SAME LINES, 2572 01:25:19,720 --> 01:25:21,440 SOMEBODY ELSE ASKED HOW DO THE 2573 01:25:21,440 --> 01:25:23,960 BRAIN BIOMARKERS TRANSLATE TO 2574 01:25:23,960 --> 01:25:24,360 DEATH? 2575 01:25:24,360 --> 01:25:25,680 DO YOU WANT TO MORE DIRECTLY 2576 01:25:25,680 --> 01:25:26,040 ADDRESS THAT? 2577 01:25:26,040 --> 01:25:29,600 >> IN OUR COHORT, PEOPLE WITH 2578 01:25:29,600 --> 01:25:31,200 HIGHER MARKERS, 2579 01:25:31,200 --> 01:25:32,560 NEURODEGENERATIVE MARKERS ALSO 2580 01:25:32,560 --> 01:25:33,800 HAD HIGHER RATES OF DEATH, BUT 2581 01:25:33,800 --> 01:25:35,320 THAT'S NOT ADJUSTING FOR ALL OF 2582 01:25:35,320 --> 01:25:36,400 THEIR FACTORS. 2583 01:25:36,400 --> 01:25:38,560 AND IT'S NOT SURPRISING THAT 2584 01:25:38,560 --> 01:25:40,240 PEOPLE WHO ARE SERIOUSLY ILL 2585 01:25:40,240 --> 01:25:43,080 HAVE LOW OXYGEN LEVELS, THEIR 2586 01:25:43,080 --> 01:25:46,960 BRAIN IS STAR OFFED STAFF, 2587 01:25:46,960 --> 01:25:49,480 THERE'S GOING TO BE SOME IMPACT 2588 01:25:49,480 --> 01:25:49,800 THERE. 2589 01:25:49,800 --> 01:25:51,320 IT'S NOT DIRECTLY CAUSAL, 2590 01:25:51,320 --> 01:25:52,720 MEANING THAT THAT BRAIN INJURY 2591 01:25:52,720 --> 01:25:54,520 LED TO THAT PERSON'S DEATH, BUT 2592 01:25:54,520 --> 01:25:56,040 IT IS A MARKER THAT THESE FOLKS 2593 01:25:56,040 --> 01:25:57,960 WERE REALLY SICK AND THAT 2594 01:25:57,960 --> 01:26:01,040 SOMETHING HAS INDEED HAPPENED TO 2595 01:26:01,040 --> 01:26:02,600 THEIR BRAIN, IT'S NOT JUST THAT 2596 01:26:02,600 --> 01:26:04,200 THEY HAVE LOW OXYGEN LEVELS AND 2597 01:26:04,200 --> 01:26:05,160 THEY'RE DYING IN HOSPITAL 2598 01:26:05,160 --> 01:26:06,880 BECAUSE OF LOW RESPIRATORY 2599 01:26:06,880 --> 01:26:07,640 PROBLEMS. 2600 01:26:07,640 --> 01:26:08,400 THERE'S NEUROLOGICAL IMPACT 2601 01:26:08,400 --> 01:26:08,600 ALSO. 2602 01:26:08,600 --> 01:26:13,240 >> WE RECENTLY PUBLISHED 2603 01:26:13,240 --> 01:26:16,440 BASICALLY A LIFE CHAIN IN PEOPLE 2604 01:26:16,440 --> 01:26:19,440 50 TO 65 WHEN THEY ELEVATED -- 2605 01:26:19,440 --> 01:26:20,480 ASSOCIATED WITH EARLIER DEATHS 2606 01:26:20,480 --> 01:26:22,760 AND WE SAW TODAY COVID PUSHES 2607 01:26:22,760 --> 01:26:23,760 THOSE UP. 2608 01:26:23,760 --> 01:26:25,760 IT'S SAYING THAT IF THERE'S 2609 01:26:25,760 --> 01:26:28,160 DAMAGE TO PARTS OF THE TISSUE, 2610 01:26:28,160 --> 01:26:31,000 IT'S MORE LIKELY TO ACCELERATE 2611 01:26:31,000 --> 01:26:31,240 DEATH. 2612 01:26:31,240 --> 01:26:34,120 AND I THINK WE HAVE TO RECOGNIZE 2613 01:26:34,120 --> 01:26:35,760 THAT THAT IS MOST LIKELY THE 2614 01:26:35,760 --> 01:26:36,200 OUTCOME. 2615 01:26:36,200 --> 01:26:39,400 WE HAVEN'T LOOKED CAREFULLY TO 2616 01:26:39,400 --> 01:26:40,400 SEE WHAT'S HAPPENING TO DEATHS, 2617 01:26:40,400 --> 01:26:42,480 BUT IF WE LOOK, WE'VE DROPPED 2618 01:26:42,480 --> 01:26:45,040 THE AGE OF DEATH IN AMERICA 2619 01:26:45,040 --> 01:26:46,960 FAIRLY DRAMATICALLY OVER THE 2620 01:26:46,960 --> 01:26:48,040 LAST TWO YEARS, AND WE CAN SAY 2621 01:26:48,040 --> 01:26:49,840 THAT THAT OCCURRED NOT BECAUSE 2622 01:26:49,840 --> 01:26:53,240 OF COVID BUT BECAUSE OF 2623 01:26:53,240 --> 01:26:54,960 SOMETHING ELSE, BUT IT'S EITHER 2624 01:26:54,960 --> 01:26:56,920 ACUTE COVID BUT I THINK IT'S 2625 01:26:56,920 --> 01:26:58,480 MOST PROBABLY A COMBINATION. 2626 01:26:58,480 --> 01:26:59,840 AND I THINK WE NEED TO BE VERY 2627 01:26:59,840 --> 01:27:01,720 AWARE OF THAT AS WE GO FORWARD. 2628 01:27:01,720 --> 01:27:04,400 >> AND THERE'S ANOTHER RELATED 2629 01:27:04,400 --> 01:27:05,400 QUESTION, I'M NOT SURE WHO'S 2630 01:27:05,400 --> 01:27:06,720 BEST TO ANSWER THIS ONE, BUT 2631 01:27:06,720 --> 01:27:08,680 DOES COVID OR LONG COVID CAUSE 2632 01:27:08,680 --> 01:27:11,000 FASTER AGING IN GENERAL? 2633 01:27:11,000 --> 01:27:12,000 HAVE ANY STUDIES LOOKED AT 2634 01:27:12,000 --> 01:27:16,520 WHETHER IT INCREASES BIOLOGICAL 2635 01:27:16,520 --> 01:27:16,680 AGE? 2636 01:27:16,680 --> 01:27:20,440 ANYONE WANT TO TAKE THAT ONE? 2637 01:27:20,440 --> 01:27:22,000 >> THERE ARE NO DIRECT STUDIES 2638 01:27:22,000 --> 01:27:22,880 THAT I'M AWARE. 2639 01:27:22,880 --> 01:27:26,160 BUT AGAIN, THE INCREASE IN NFL 2640 01:27:26,160 --> 01:27:27,360 WHICH GOES ALONG WITH AGING 2641 01:27:27,360 --> 01:27:30,280 WOULD BE ONE OF THOSE. 2642 01:27:30,280 --> 01:27:32,120 INCREASED CYTOKINES TEND TO 2643 01:27:32,120 --> 01:27:35,960 INCREASE THE RATE OF AGING, AT 2644 01:27:35,960 --> 01:27:37,760 LEAST IN ANIMALS, WE'VE DONE A 2645 01:27:37,760 --> 01:27:41,040 LOT OF STUDIES WITH ALZHEIMER'S 2646 01:27:41,040 --> 01:27:42,040 MODEL -- ALZHEIMER'S SHOWING 2647 01:27:42,040 --> 01:27:42,440 THAT'S THE CASE. 2648 01:27:42,440 --> 01:27:45,200 SO I THINK WE SHOULD ASSUME THAT 2649 01:27:45,200 --> 01:27:48,080 IT'S TRUE IN OUR NURSING HOME 2650 01:27:48,080 --> 01:27:49,040 STAFF, WE'RE FINDING A LARGE 2651 01:27:49,040 --> 01:27:50,640 NUMBER OF STAFF WHO CAN'T COME 2652 01:27:50,640 --> 01:27:55,560 BACK TO WORK A YEAR LATER, THEY 2653 01:27:55,560 --> 01:27:57,240 STILL FATIGUE AND THEY FINISH UP 2654 01:27:57,240 --> 01:27:57,640 RETIRING. 2655 01:27:57,640 --> 01:28:01,880 SO FUNDAMENTALLY, I THINK THAT 2656 01:28:01,880 --> 01:28:03,320 THE MOST -- THOSE ARE STUDIES 2657 01:28:03,320 --> 01:28:05,400 THAT NEED TO BE DONE AND HE? 2658 01:28:05,400 --> 01:28:07,800 ARE LONG AND THEY 2659 01:28:07,800 --> 01:28:08,560 ARE LONG TERM STUDIES. 2660 01:28:08,560 --> 01:28:10,800 YOU'RE NOT GOING TO GET THE 2661 01:28:10,800 --> 01:28:11,360 ANSWER IN SIX MONTHS. 2662 01:28:11,360 --> 01:28:13,360 IT'S GOING TO TAKE YEARS TO 2663 01:28:13,360 --> 01:28:14,400 UNDERSTAND WHETHER WE'RE 2664 01:28:14,400 --> 01:28:16,200 ACCELERATING AGING, WHETHER OR 2665 01:28:16,200 --> 01:28:17,520 NOT PEOPLE WHO'VE HAD COVID ARE 2666 01:28:17,520 --> 01:28:19,240 GOING TO DIE TWO, FOUR YEARS 2667 01:28:19,240 --> 01:28:21,800 LATER EVEN IF THEY DON'T HAVE 2668 01:28:21,800 --> 01:28:24,200 LONG COVID, WHAT THE TWO LONG 2669 01:28:24,200 --> 01:28:25,200 OUTCOMES ARE GOING TO BE. 2670 01:28:25,200 --> 01:28:27,040 I THINK WE NEED TO PAY A LOT OF 2671 01:28:27,040 --> 01:28:29,280 ATTENTION TO THAT. 2672 01:28:29,280 --> 01:28:30,640 THAT'S MY OPINION. 2673 01:28:30,640 --> 01:28:31,880 AGAIN, WE DON'T HAVE ANY SCIENCE 2674 01:28:31,880 --> 01:28:33,960 TO BACK IT AT THE MOMENT. 2675 01:28:33,960 --> 01:28:35,440 >> OKAY, THANK YOU ALL VERY 2676 01:28:35,440 --> 01:28:37,480 MUCH. 2677 01:28:37,480 --> 01:28:40,000 IT SHOWS ON MY CLOCK AS NOON 2678 01:28:40,000 --> 01:28:41,760 EASTERN, AND THAT IS OUR END 2679 01:28:41,760 --> 01:28:44,440 TIME, SO I WANT TO THANK 2680 01:28:44,440 --> 01:28:46,080 EVERYONE, THE SPEAKERS, THE 2681 01:28:46,080 --> 01:28:47,760 ATTENDEES AND THE FUTURE 2682 01:28:47,760 --> 01:28:49,040 WATCHERS OF OUR WEBINAR. 2683 01:28:49,040 --> 01:28:50,720 I HOPE THAT YOU ALL STAY TUNED 2684 01:28:50,720 --> 01:28:55,040 FOR UPDATES ABOUT OUR UPCOMING 2685 01:28:55,040 --> 01:28:57,960 FOCUS ON AGING FEDERAL PARTNERS' 2686 01:28:57,960 --> 01:28:58,800 WEBINARS, AND THERE'S THE LINK 2687 01:28:58,800 --> 01:29:00,160 ON THE SCREEN TO BE ABLE TO KEEP 2688 01:29:00,160 --> 01:29:01,760 UP, AND AGAIN, THANK YOU ALL 2689 01:29:01,760 --> 01:29:02,680 VERY, VERY MUCH. 2690 01:29:02,680 --> 00:00:00,000 TAKE CARE.