THANK YOU FOR JOINING US FOR OUR
FEDERAL PARTNERS' WEBINAR SERIES
IN THE FOCUS ON AGING SERIES.
TODAY'S TOPIC IS COVID-19.
WE ON BEHALF OF OUR FEDERAL
PARTNERS, I WANT TO WELCOME YOU,
AND OUR FEDERAL PARTNERS' LOGOS
ARE LISTED BELOW.
THEY ARE THE ADMINISTRATION FOR
COMMUNITY LIVING, THE HEALTH AND
HUMAN SERVICES OFFICE OF THE
ASSISTANT SECRETARY FOR PLANNING
AND EVALUATION, THE CDC, CMS,
WHICH IS CENTERS FOR MEDICARE
AND MEDICAID SERVICES, HRSA,
WHICH IS HEALTH RESOURCES AND
SERVICES ADMINISTRATION, THE
IHS, THE INDIAN HEALTH SERVICE,
US AT THE NATIONAL INSTITUTE ON
AGING, WHICH IS PART OF THE
NATIONAL INSTITUTES OF HEALTH,
AND THE U.S. DEPARTMENT OF
VETERANS AFFAIRS.
SO THE WEBINAR OVERVIEW, TODAY'S
WEBINAR WILL FEATURE
PRESENTATIONS ON THE FOLLOWING.
ONE IS GOING TO BE AN OVERVIEW
OF COVID-19 AND AGING GENERALLY.
THE NEXT WILL BE IMPACT OF THE
COVID-19 PANDEMIC ON THE
WELL-BEING OF OLDER ADULTS FROM
UNDERSERVED COMMUNITIES, THEN
WE'LL HEAR ABOUT LONGITUDINAL
TRAJECTORIES OF COGNITIVE AND
FUNCTIONAL RECOVERY AFTER SEVERE
COVID-19.
NEXT WE'LL HEAR COVID-19 AND
DEMENTIA, TRANSLATING FINDINGS
FROM THE INITIAL NEW YORK CITY
WAVE INTO LONGITUDINAL STUDIES
OF COGNITIVE AGING.
AND FINALLY, COVID-19 AND LONG
COVID IN LONG-TERM CARE
SETTINGS.
OUR ILLUSTRIOUS SPEAKERS TODAY,
WE HAVE FIVE OF THEM.
DR. PETER BRISS FROM THE
NATIONAL CENTER FOR CHRONIC
DISEASE PREVENTION AND HEALTH
PROMOTION AT THE CDC.
DR. MARIA MARQUINE, FROM DUKE
UNIVERSITY, DEPARTMENT OF
MEDICINE, DIVISION OF
GERIATRICS, DUKE CENTER FOR THE
STUDY OF AGING AND HUMAN DEVELOP
DEVELOPMENT.
NEXT, DR. JENNIFER FRONTERA FROM
THE NEW YORK UNIVERSITY LANGEONE
HEALTH.
THEN DR. JAMES NOBLE, IRVINGTON
MEDICAL CENTER, AND FINALLY, DRR
EMERITUS FROM ST. LOUIS
UNIVERSITY.
WE'RE GOING TO HAVE A QUESTION
AND ANSWER SESSION PERIOD AT THE
END.
AS YOU CAN HEARING SPEAKERS, YOU
ARE INVITED TO PROVIDE US WITH
YOUR QUESTIONS, AND THE WAY YOU
DO THAT IS CLICK ON THE LIVE
FEEDBACK BUTTON AT THE BOTTOM OF
THE VIDEOCAST PAGE TO SUBMIT
THAT QUESTION.
WE WILL BEGIN WITH DR. BRISS.
>> GOOD MORNING, EVERYONE.
I'M DELIGHTED TO BE HERE THIS
MORNING, AND I'LL OPEN WITH AN
OVERVIEW OF COVID AND AGING.
SO THE STRUCTURE OF MY
DISCUSSION TODAY WILL ADDRESS
SEVERAL INTERRELATED ISSUES, SO
AGING ITSELF, ASSOCIATIONS OF
AGING AND CHRONIC CONDITIONS AND
DISABILITY, AND THE IMPACTS OF
ADVERSE SOCIAL DETERMINANTS OF
HEALTH.
AFTER I TEE UP SOME ISSUES ABOUT
HOW ALL THOSE THINGS RELATE TO
COVID-19, WE'LL TALK A LITTLE
ABOUT HOW TO PROTECT YOURSELF
AND OTHERS.
SO OLDER ADULTS ARE AT INCREASED
RISK OF SERIOUS OUTCOMES OF
COVID-19.
NEARLY THREE QUARTERS OF ALL
COVID-19-RELATED DEATHS IN THE
UNITED STATES HAVE OCCURRED IN
PEOPLE WHO ARE AGED 65 YEARS AND
OLDER.
IN THE U.S. AND ELSEWHERE, OLDER
ADULTS WERE A PRIORITY
POPULATION FOR COVID-19
VACCINATION, BUT ONLY ABOUT 40%
OF PEOPLE AGED 65 AND OLDER HAVE
HAD A SECOND BOOSTER, AND
SMALLER NUMBERS HAVE HAD THE
BRAND NEW BOOSTERS.
WHICH WERE RECOMMENDED IN THE
LAST COUPLE OF WEEKS.
MORTALITY RATES HAVE BEEN HIGHER
IN PLACES LIKE HONG KONG, WHERE
OLDER ADULTS WERE NOT
PRIORITIZED FOR VACCINATION, AND
THE RISK OF DEATH AMONG OLDER
ADULTS WHO WERE NOT VACCINATED
CAN BE 20 TIMES THE RISK IN
PEOPLE WHO WERE VACCINATED.
JUST A PROCESS POINT, I'M GOING
TO TEE UP A LOT OF ISSUES, AND
IF PEOPLE WOULD LIKE TO TAKE
DEEPER DIVES INTO ANY OF THOSE,
I'VE INCLUDED FOOTNOTES THAT
TAKE YOU TO MORE INFORMATION.
AGING IS ASSOCIATED WITH CHRONIC
CONDITIONS.
60% OF AMERICAN ADULTS HAVE AT
LEAST ONE CHRONIC CONDITION, AND
ABOUT 2 IN 5 HAVE MORE THAN ONE.
AMONG PEOPLE WHO ARE 65 AND
OLDER, 4 PEOPLE OUT OF 5 HAVE
MORE THAN ONE CHRONIC CONDITION.
DURING THE COVID-19 PANDEMIC,
MANY CHRONIC CONDITIONS SUCH AS
HEART DISEASE, CANCER, CHRONIC
LUNG DISEASES AND OTHERS WERE
ASSOCIATED WITH INCREASED
COVID-19-RELATED MORBIDITY AND
MORTALITY.
MULTIPLE CHRONIC CONDITIONS WERE
ASSOCIATED WITH HIGHER RATES OF
POOR OUTCOMES.
THE EFFECTS OF THE PANDEMIC ON
PEOPLE WITH CHRONIC CONDITIONS
WERE NOT LIMITED TO THE DIRECT
EFFECTS OF COVID-19.
DURING THE PANDEMIC, THE USE OF
HEALTHCARE SERVICES DECLINED.
FOR PREVENTIVE, ROUTINE AND EVEN
EMERGENCY CARE.
EXCESS MORTALITY DURING THE
PANDEMIC HAS BEEN OBSERVED
RELATED TO COVID-19, BUT ALSO
RELATED TO CARDIOVASCULAR
CONDITIONS, DIABETES, AND
DEMENTIA, AMONG MANY OTHERS.
THE IMPLICATIONS OF THESE
EFFECTS ARE LIKELY TO EXTEND
INTO THE RECOVERY PHASE OF THE
PANDEMIC.
FOR EXAMPLE, THERE'S
CONSIDERABLE ONGOING WORK TO
ADDRESS A COVID-19-RELATED
HEALTH DEBT THAT'S ACCUMULATED
BECAUSE OF LESS HEALTHY
BEHAVIORS AND FOREGONE MEDICAL
CARE DURING THE PANDEMIC.
ADDRESSING THESE CHRONIC
CONDITIONS NOW CAN IMPROVE
RESILIENCY AND PREPAREDNESS FOR
THE NEXT PUBLIC HEALTH
EMERGENCY.
WHILE WE CAN'T KEEP PEOPLE FROM
AGING, WE CAN DO THINGS SO THAT
THEY'RE HEALTHY AS THEY AGE.
NEXT LET'S TALK A LITTLE ABOUT
AGING AND DISABILITY.
SOME DISABILITIES INCREASE RISK
OF INFECTION OR POOR OUTCOMES
FROM COVID-19.
FOR EXAMPLE, SOME PEOPLE MAY BE
MORE LIKELY TO GET INFECTED OR
HAVE SEVERE ILLNESS BECAUSE OF
UNDERLYING MEDICAL CONDITIONS,
CONJUGATE LIVING
CONGREGATE LIVING SETTINGS OR
SYSTEMIC HEALTH AND SOCIAL
INEQUITIES.
OTHER DISABILITIES MAY HAVE
INTERFERED WITH HEALTH
PROTECTION.
THESE INCLUDE CHALLENGES WITH
ACCESSING OR PROCESSING
INFORMATION, OR ACCESSING
HEALTHCARE AND OTHER ESSENTIAL
SERVICES.
IT'S CLEAR THAT DURING COVID-19,
DISABILITY WASN'T ADDRESSED
EARLY OR SYSTEMATICALLY ENOUGH.
LAST, LET'S TALK ABOUT SOCIAL
DETERMINANTS OF HEALTH.
THE COVID-19 PANDEMIC
UNDERSCORED HOW DIFFERENCES IN
SOCIAL AND STRUCTURAL FACTORS
HAVE SIGNIFICANT IMPACTS ON
HEALTH AND ILLNESS.
ISSUES LIKE OCCUPATION, POVERTY,
HOUSING, PERSONAL SPACE, PLACES
FOR PHYSICAL ACTIVITY, FOOD AND
NUTRITION SECURITY, AND
HEALTHCARE, AMONG MANY OTHERS,
HAVE CONTRIBUTED TO DISPARITIES
IN OUTCOMES OF COVID-19.
SO WHAT NOW?
WE HAVE LOTS OF TOOLS TO PROTECT
OURSELVES AND OUR COMMUNITIES
FROM SEVERE ILLNESS.
THESE INCLUDE VACCINATIONS,
BOOSTERS, AND EFFECTIVE
TREATMENTS.
CDC IS CONTINUING TO STREAMLINE
AND SIMPLIFY ITS GUIDANCE,
ACKNOWLEDGING THAT THE PANDEMIC
IS NOT OVER AND PROVIDING PEOPLE
WITH TOOLS TO PROTECT
THEMSELVES, BUT ALSO HELPING US
MOVE TO A POINT WHERE COVID-19
NO LONGER SEVERELY DISRUPTS OUR
DAILY LIVES.
TOOLS TO PROTECT YOURSELF AND
OTHERS INCLUDE HIGHLY EFFECTIVE
VACCINES AND TREATMENTS, TREATM.
VACCINATION REMAINS THE BEST WAY
TO PROTECT FROM SEVERE COVID-19
HOSPITALIZATION AND DEATH, AND
COVID-19 VACCINES AND BOOSTERS
ARE SAFE, EFFECTIVE, AND FREE.
STRONGER PROTECTIONS ARE
NECESSARY AT HIGH COMMUNITY
LEVELS, AND FOR PEOPLE AT HIGHER
RISK OF GETTING VERY SICK WITH
COVID-19.
THESE PROTECTIONS INCLUDE
WEARING HIGH QUALITY MASKS, OR
RESPIRATORS, AND EARLY ACCESS TO
AND USE OF TREATMENTS QUICKLY
AFTER INFECTION.
THE NEXT STEP IS UNDERSTANDING
YOUR RISK.
THE THINGS WE'VE BEEN TALKING
ABOUT THIS MORNING, LIKE OLDER
AGE, HAVING A DISABILITY, A
WEAKENED IMMUNE SYSTEM, AND
CERTAIN HEALTH CONDITIONS
INCREASE A PERSON'S RISK FOR
SEVERE ILLNESS FROM COVID-19 AND
WARRANT GREATER USE OF LAYERED
PREVENTION STRATEGIES.
WE SHOULD PROTECT OTHERS IF
WE'RE EXPOSED.
FOLLOW CDC'S RECOMMENDATIONS ON
WHAT TO DO IF YOU'RE EXPOSED,
INCLUDING WEARING A HIGH QUALITY
MASK INDOORS AND AROUND OTHERS
AS SOON AS YOU FIND OUT THAT YOU
WERE EXPOSED.
GET TESTED, AND WATCH CLOSELY
FOR SYMPTOMS FOR 10 FULL DAYS.
TAKE ACTION IF YOU'RE SICK TO
PROTECT BOTH YOURSELF AND THE
PEOPLE AROUND YOU.
ASSURE EARLY ACCESS TO AND
APPROPRIATE USE OF TREATMENTS.
IF YOU HAVE SYMPTOMS, GET TESTED
AND STAY HOME UNTIL YOU HAVE
YOUR RESULTS.
AND IF YOU HAVE TESTED POSITIVE,
FOLLOW CDC'S ISOLATION
RECOMMENDATIONS, INCLUDING
STAYING HOME AND AWAY FROM
OTHERS FOR AT LEAST 5 DAYS,
WEARING A HIGH QUALITY MASK WHEN
INDARS
INDOORS AND AROUND OTHERS.
I'LL FINISH WITH A COUPLE OF
RESOURCES.
SEARCH FIND HELP IS AN ONLINE
LIBRARY WITH HUNDREDS OF
RESOURCES FOR ORGANIZATIONS THAT
SERVE OLDER ADULTS AND THEIR
CAREGIVERS.
WHAT IS ALZHEIMER'S DISEASE?
AND EMERGENCY PREPAREDNESS FOR
OLDER ADULTS, INCLUDING
COVID-19.
THANK YOU VERY MUCH, AND I WILL
PASS THE BATON OVER.
>> GOOD MORNING.
I'D LIKE TO START BY THANKING
THE WEBINAR ORGANIZERS FOR
INVITING ME TO BE PART OF THIS
IMPORTANT PANEL.
MY NAME IS MARIA MARQUINE.
I'M A FACULTY MEMBER AND
SCIENTIST IN THE DIVISION OF
GERIATRICS IN THE DEPARTMENT OF
MEDICINE IN THE DUKE CENTER FOR
THE STUDY OF AGING AND HUMAN
DEVELOPMENT AT DUKE UNIVERSITY
SCHOOL OF MEDICINE.
IT'S A PLEASURE FOR ME TO BE
HERE TODAY, AND I'M GOING TO BE
SHARING WITH YOU WHAT REALLY WAS
THE RESULT OF A LARGE EFFORT BY
SEVERAL INVESTIGATORS IN THE
UNITED STATES AND ACROSS LATIN
AMERICA THAT CAME TOGETHER VERY
EARLY ON DURING THE PANDEMIC
UNDER THE MENTORSHIP OR THE
LEADERSHIP OF HARVARD
UNIVERSITY, WHO BROUGHT US
TOGETHER TO UNDERSTAND, AS
THINGS WERE HAPPENING, HOW THE
PANDEMIC WAS CHANGING THE LIVES
OF MIDDLE AND OLDER AGED ADULTS
THAT ARE FROM UNDERSERVED
COMMUNITIES AND OFTEN
UNDERREPRESENTED IN RESEARCH.
OKAY.
SO BEFORE I SHARE MY WORK, I'D
LIKE -- THANK YOU.
NOW I HAVE ACCESS TO THE
PRESENTATION.
I APOLOGIZE FOR THAT.
OKAY.
I APOLOGIZE FOR THAT.
SOME TECHNICAL DIFFICULTIES.
OKAY.
SO BEFORE I SHARE OUR WORK, I'D
LIKE TO START BY SHARING SOME OF
THE STATISTICS FROM THE CDC THAT
SHOW THE NUMBER -- THE PERCENT
OF COVID-19 CASES AND DEATH BY
RACE/ETHNICITY OF PEOPLE AGE
65 AND OLDER.
SO WHAT YOU SEE REPRESENTED HERE
IS THE DATA FOR THE OLDER ADULT
POPULATION IN THE U.S. AS OF
SEPTEMBER 2ND, SO JUST LAST
WEEK.
AND YOU SEE IT BROKEN DOWN BY
THE MAIN RACIAL ETHNIC GROUPS IN
THE UNITED STATES.
SO IF YOU LOOK FOR EXAMPLE OVER
HERE, THE HISPANIC LATINO
POPULATION, WHAT IS REPRESENTED
IN GREY IS THE PERCENT OF THE
POPULATION AGED 65 AND OVER THAT
IS LATINO IN THE U.S. OR
HISPANIC.
IN BLUE, WHAT YOU SEE ARE THE
PROPORTION OF COVID-19 CASES
THAT ARE FROM THIS RACIAL ETHNIC
GROUP, AND IN RED, YOU SEE THE
PROPORTION OF DEATHS ATTRIBUTED
TO COVID-19 THAT ARE MEMBERS OF
THIS GROUP.
SO WHAT WE SEE IS A
DISPROPORTIONATE IMPACT OF THE
COVID-19 CASES IN DEATHS IN THE
LATINO POPULATION.
WE SEE SIMILAR TRENDS IN THE
AMERICAN INDIAN/ALASKA NATIVE
COMMUNITY AND THE
BLACK/NON-LATINO COMMUNITY.
OTHER GROUPS, WE SEE A LITTLE
BIT LESS IMPACT RELATIVE TO THE
PROPORTION OF THE POPULATION OF
COVID-19 CASES AND DEATHS.
ANOTHER WAY TO LOOK AT SOME OF
THE DATA SHOWN BY THE CDC IS THE
NUMBER OF DEATHS ASSOCIATED WITH
COVID-19.
THIS IS OVER TIME.
SO I WANT TO POINT OUT A COUPLE
OF THINGS HERE.
I KNOW IT'S A BUSY SLIDE WITH
LOTS OF DIFFERENT THINGS, BUT IF
YOU LOOK AT THE HARD LINE HERE,
THOSE ARE PEOPLE 75 AND OVER,
AND THIS OTHER KIND OF DASHED
LINE ARE PEOPLE -- SORRY, THIS
IS 74 TO 5 CLASS AND 64 TO
65 CLASS.
SO WHAT YOU SEE IN ALL DIFFERENT
RACIAL ETHNIC GROUPS IS
DISPROPORTIONATE NUMBER OF
DEATHS AMONG THE OLDER
POPULATION AS WAS PREVIOUSLY
MENTIONED, AND THE OTHER THING
THAT YOU SEE OR THAT I'D LIKE TO
POINT OUT IS THAT CERTAIN
GROUPS, AGAIN, HAVE THE SPIKES
THAT ARE MUCH LARGER THAN SOME
OTHER GROUPS.
AGAIN SHOWING HOW OVER TIME, THE
NUMBER OF DEATHS HAVE CONTINUED
TO BE INCREASED IN CERTAIN
RACIAL OR ETHNIC GROUPS.
AND THIS IS STILL THE CASE.
SO AS I AGAIN MENTIONED THE
PRIOR PRESENTATION BY DR. BRISS,
THE PANDEMIC IS ONGOING.
THERE'S STILL QUITE A BIT OF
IMPACT, ESPECIALLY IN CERTAIN
GROUPS OF OUR POPULATION.
I WILL NOW START SHARING SOME OF
THE FINDINGS AGAIN FROM OUR
GROUP.
IT'S A LARGE GROUP, AND THESE
WERE PUBLISHED LAST YEAR, SOME
OF THE THINGS I'M SHARING WITH
YOU.
WE WERE ABLE TO RECRUIT A GROUP
OF CLOSE TO 900 COMMUNITY
DWELLING ADULTS AGE 50-PLUS
LIVING IN THE UNITED STATES.
AS I MENTIONED BEFORE, WE ALSO
HAD A NUMBER OF COUNTRIES IN
LATIN AMERICA.
I WILL FOCUS MY PRESENTATION ON
THE U.S. SAMPLE.
SO WE HAD PRIMARILY THREE
MEMBERS OR THREE ETHNIC RACIAL
GROUPS, WHITE, HISPANICS AND
BLACKS, AND YOU SEE THE MEAN AGE
WAS AROUND 65.
PRETTY WELL -- A LIMITATION OF
OUR FINDINGS, SOMETHING TO KEEP
IN MIND, AND IT'S NOT COMPLETELY
REPRESENTATIVE OF THE OVERALL
POPULATION AND MOSTLY FEMALE.
SO OUR PARTICIPANTS,
PARTICIPANTS IN THIS STUDY,
COMPLETED A SURVEY EITHER ONLINE
OR BY PHONE BETWEEN MAY AND
SEPTEMBER OF 2020, SO VERY EARLY
ON IN THE PANDEMIC.
WHERE THERE WAS A LOT OF
UNCERTAINTY, OF COURSE THERE
STILL IS A LOT OF UNANSWERED
QUESTIONS, ESPECIALLY AT THAT
TIME, A LOT OF THINGS WERE
CLOSED DOWN AT THAT POINT.
PARTICIPANTS COMPLETED THE
SURVEY THAT ASKED FOR A NUMBER
OF DIFFERENT MEASURES HAVING TO
DO WITH WELL-BEING AND THE
IMPACT ON PEOPLE'S LIVES.
I'M GOING TO FOCUS ON TWO MAIN
MEASURES THAT WE GATHERED.
ONE WAS THE IMPACT OF THE
PANDEMIC ON SEVERAL ASPECTS OF
LIFE VIA THE EPIDEMIC PANDEMIC
IMPACT INVENTORY, AND ALSO THE
REPORT OF COGNITIVE SYMPTOMS OR
COGNITIVE PROBLEMS AT THAT TIME
RELATIVE TO BEFORE THE PANDEMIC.
SO WHAT YOU SEE REPRESENTED HERE
ARE FINDINGS FROM THE POTENTIAL
INFECTION HISTORIMENT HIS.
BACK THEN IT WAS HARD TO GET
ACCESS TO TESTING IN CERTAIN
POPULATIONS AND SO FORTH.
I'LL SHOW IN THE NEXT FEW SLIDES
SIMILAR GRAPHS AS THIS ONE FOR
DIFFERENT DOMAINS OF LIFE, AND
THE IMPACT OF THE PANDEMIC ON
LIFE.
IN GREY, YOU WILL SEE
REPRESENTED THE NON-LATINO
NON-HISPANIC WHITE GROUP, IN
RED, THE HISPANIC LATINO GROUP,
AND IN GREEN, NON-HISPANIC
BLACKS.
AND IN REFERS TO THEIR INFECTION
HISTORY.
THESE ARE THE ITEMS INCLUDED IN
THIS SCALE.
SO -- WHICH ARE BASICALLY HAVING
SYMPTOMS WITH THE DISEASE,
HAVING BEEN TESTED THINKING THEY
MIGHT HAVE THE DISEASE.
THIS EARLY ON IN OUR SAMPLE, WE
ALREADY SAW THAT HISPANICS AND
LATINOS HAD A WORSE INFECTION
HISTORY COMPARED TO NON-LATINO
WHITES AND A TREND IN BLACKS AS
WELL.
WHEN IT CAME TO THE ECONOMIC
IMPACT OF THE PANDEMIC AT THAT
POINT IN TIME, WE ALSO SAW THAT
THERE WAS MORE FINANCIAL
HARDSHIP AMONG HISPANIC LATINOS
THAN NON-HISPANIC WHITES AND
BLACKS AS ASSESSED BY THE
SUBSCALE INCLUDING THESE ITEMS
HERE AS YOU SEE LISTED, LIKE AN
INABILITY TO GET ENOUGH FOOD OR
HEALTHY FOOD, ACCESS CLEAN
WATER, ET CETERA.
SO LATINOS ARE REPORTING HAVING
MORE TROUBLE WITH THIS, HAVING A
GREATER ECONOMIC IMPACT AT THAT
TIME.
WE ALSO -- SORRY, THIS IS
FREEZING UP AND I CANNOT
ADVANCE.
IT'S NOT LETTING ME ADVANCE.
I'M NOT SURE IF I.T. WANTS TO
TAKE CONTROL AND ADVANCE THE
SLIDES?
>> I NEED 10 SECONDS.
I'M SORRY ABOUT THAT.
>> NO PROBLEM.
I'M SORRY TO THE AUDIENCE ABOUT
IT.
HOPEFULLY WE'LL GET GOING FAIRLY
SOON.
SO AS THE TECHNICAL DIFFICULTIES
ARE BEING SORTED OUT, I THINK,
YOU KNOW, OVERALL, SOME OF OUR
SLIDES, WHAT ARE SHOWING AT THIS
POINT IS THIS DISPROPORTIONATE
IMPACT OF THE PANDEMIC IN THE
LIVES OF PEOPLE FROM
UNDERREPRESENTED MINORITIZED
GROUPS IN THE U.S., SO WE KNOW
THAT THE PANDEMIC IMPACTED
BASICALLY THE LIFE OF EVERYONE
IN ONE WAY OR ANOTHER.
BUT IT WAS -- THIS IMPACT HAS
BEEN DISPROPORTIONATE IN CERTAIN
GROUPS, AND THE SOCIOCULTURAL
CONTEXT IS IMPORTANT TO KEEP IN
MIND AS WE SEE VAL WAIT WHAT HAS
BEEN THE IMPACT OF THE PANDEMIC
AND WHAT MIGHT CONTINUE TO BE IN
THE FUTURE.
SO I THINK NOW I HAVE ACCESS
AGAIN.
LET ME SEE.
I DO.
THANK YOU FOR THAT.
SO WE WERE HERE IN THE ECONOMIC
IMPACT.
I'LL MOVE FORWARD TO THE NEXT
ONE.
SO ANOTHER SCALE EVALUATED THE
IMPACT OF THE PANDEMIC ON
PEOPLE'S HOME LIFE, AND AGAIN
YOU SEE THE ITEMS IN THE SCALE
REPRESENTED HERE TO GIVE YOU A
SENSE OF HOW THIS WAS ASSESSED.
SO THERE'S VERY DIFFERENT IN
MANY WAYS BUT INCREASE IN VERBAL
ARGUMENTS, PHYSICAL CONFLICTS
WITH SPOUSES, PARTNERS, OTHER
PEOPLE IN THE HOMEMENT HOM.
AND WHAT WE SAW FOR THIS SCALE
IS THAT AMONG NON-LATINO AND
NON-HISPANIC BLACKS, THIS
CHANGES IN HOME LIFE, NEGATIVE
CHANGES IN HOME LIFE HAPPENED
MORE OFTEN OR MORE FREQUENTLY
THAN FOR OTHER GROUPS.
HERE THE SCALE ASSESSED THE
LIMITATIONS IN SOCIAL ACTIVITIES
AND HAVING TO DISTANCE
PHYSICALLY, WHICH WAS QUITE
PREVALENT AT THAT POINT.
THERE WERE NO SIGNIFICANT GROUP
DIFFERENCES BUT EVERYBODY WAS
HAVING TO DO THAT QUITE A BIT AT
THAT TIME.
THEN EMOTIONAL HEALTH, WE DIDN'T
SEE SIGNIFICANT DIFFERENCES
ACROSS GROUPS, BUT WE DID SEE
THAT A LOT OF PEOPLE WERE
ENDORSING CHANGES IN EMOTIONAL
HEALTH, BOTH FOR THEMSELVES AND
PEOPLE LIVING WITH THEM,
INCREASING MENTAL HEALTH
PROBLEMS, INCREASING SLEEP
PROBLEMS, ALCOHOL OR SUBSTANCE
USE.
SO QUITE NOTABLE.
SAME THING FOR PHYSICAL HEALTH,
NO SIGNIFICANT GROUP
DIFFERENCES, BUT STILL, NOTABLE
CHANGES NOTED ACROSS MANY
DIFFERENT SEGMENTS OF THE
POPULATION AS LISTED HERE, LIKE
INCREASING HEALTH PROBLEMS NOT
RELATED TO THE DISEASE, LESS
PHYSICAL ACTIVITY, ET CETERA.
THIS SLIDE, I'D LIKE TO SPEND A
LITTLE BIT MORE TIME ON.
WHAT I'VE BEEN DISCUSSING UP
UNTIL NOW ARE MOSTLY CAPTURED
UNDER THE UMBRELLA OF NEGATIVE
IMPACTS ON DAILY LIFE OF PEOPLE.
NOW, WHAT THIS SUBSCALE SAYS IS
POSITIVE LIFE CHANGES ASSOCIATED
WITH THE PANDEMIC.
LIKE MORE QUALITY TIME WITH
FAMILY MEMBERS OR FRIENDS,
CHILDREN OR SPOUSES, IMPROVED
RELATIONSHIPS, MORE TIME IN
NATURE AND SO FORTH.
WHAT WE SAW WAS THAT BOTH FOR
THE HISPANIC LATINOS AND THE
NON-LATINO BLACKS IN OUR
SAMPLES, THESE GROUPS REPORTED
MORE POSITIVE CHANGE ASSOCIATED
WITH THE PANDEMIC, WHICH IS
SOMEWHAT STRIKING, GIVEN THAT
EITHER LATINOS OR BLACKS HAD A
LOT OF OTHER IMPACTS OF THE
PANDEMIC THAT WERE NEGATIVE.
SO THIS WAS SOME POSITIVE THINGS
THAT WERE NOTED.
AS I MENTIONED BRIEFLY BEFORE,
WE ALSO ASSESSED SELF-REPORT OF
COMMON SYMPTOMS, IN THIS CASE,
PEOPLE REPORTING PROBLEMS WITH
MEMORY, THINKING, AND OTHER
PROCESSING SPEED, OTHER SKILLS.
WE SAW THAT ACTUALLY NON-LATINO
WHITES REPORTED MORE COGNITIVE
SYMPTOMS THAN HISPANIC LATINOS
AND BLACKS.
AND GREATER NEGATIVE IMPACT OF
THE PANDEMIC WAS ASSOCIATED WITH
MORE COGNITIVE SYMPTOMS ACROSS
GROUPS.
SO BASICALLY THE MORE RELATED
LIFE CHANGES, THE MORE THAT
PEOPLE WERE NOTICING COGNITIVE
CHANGES OR CHANGES IN THINKING
OR MEMORY, WHICH CAN BE IN SOME
CASES A PRECURSOR FOR MORE
IMPORTANT PROBLEMS LIKE
ALZHEIMER'S DISEASE.
I'M GOING TO SHARE VERY BRIEFLY
SOME OF OUR RESULTS OF OUR LATIN
AMERICAN SAMPLE, WHICH IS THE
DEMOGRAPHICS ARE DEPICTED HERE,
SO AGAIN, THEY WERE PEOPLE 50
PLUS, PRIMARILY FEMALE, YOU SEE
SOME OF THE STATISTICS THERE.
A NUMBER OF COUNTRIES IN SOUTH
AMERICA, CENTRAL AMERICA AND THE
CARIBBEAN.
THE MAIN REASON WHY I'M KIND OF
GIVING YOU A GLIMPSE OF THIS
SAMPLE, THESE FINDINGS
REPRESENTED AT THE ALZHEIMER'S
ASSOCIATION INTERNATIONAL
CONFERENCE IS THAT WE LOOKED AT
THE DATA IN A SOMEWHAT DIFFERENT
WAY, INVESTIGATING WHAT WAS BOTH
THE NEGATIVE AND POSITIVE, HOW
DID BOTH NEGATIVE AND POSITIVE
LIFE CHANGES IMPACT COGNITIVE
SYMPTOMS IN THIS OLDER SAMPLE?
WHAT WE SAW IS THAT SIMILAR TO
WHAT WE HAD SEEN IN OUR U.S.
SAMPLE, MORE NEGATIVE LIFE
CHANGES WERE ASSOCIATED WITH
MORE COGNITIVE SYMPTOMS, MORE
COGNITIVE PROBLEMS.
HOWEVER, THIS ASSOCIATION WAS
MUCH WEAKER IN PEOPLE THAT
REPORTED AT LEAST ONE POSITIVE
THING ASSOCIATED WITH THE
CURRENT PANDEMIC.
SUGGESTING THAT BEING ABLE TO
EXPERIENCE AT LEAST ONE POSITIVE
CHANGE CAN SIGNIFICANTLY BUFFER
THE NEGATIVE IMPACT OF NEGATIVE
THINGS HAPPENING IN YOUR LIFE
WITH THE ONSET OF COGNITIVE
PROBLEMS.
SO TO CONCLUDE, WE OBSERVED
RACIAL ETHNIC DIFFERENCES ON THE
IMPACT OF COVID-19 PANDEMIC IN
OUR U.S. SAMPLE IN THE LIVES OF
PEOPLE WITH USUALLY MINORITIZED
GROUP PRESENTING WITH A MORE
INCREASED NEGATIVE IMPACT OF THE
PANDEMIC ON THEIR LIVES, BUT
DESPITE THIS, THESE GROUPS ALSO
REPORTED -- WERE MORE LIKELY TO
REPORT POSITIVE LIFE CHANGES
ASSOCIATED WITH THE PANDEMIC AS
WELL.
ONE MORE NEGATIVE, LIFE CHANGES
RELATED TO MORE COGNITIVE
SYMPTOMS.
THIS ASSOCIATION WAS
CONSIDERABLY LESS STRONG IN
PEOPLE WITH POSITIVE LIFE
CHANGES THAT WERE ABLE TO
REPORT.
SO OUR STUDIES, OF COURSE, HAVE
SOME LIMITATIONS, LIKE THIS IS
NOT A POPULATION-BASED STUDY.
IT'S A SAMPLE OF -- WHAT WE CALL
A SAMPLE OF CONVENIENCE, AND WE
AT THIS POINT HAVE SELF-REPORTED
COGNITIVE SYMPTOMS.
SOME OF THE FUTURE DIRECTIONS
THAT WE ARE EXPLORING RIGHT NOW
ARE TO EXAMINE THE LONG TERM
IMPACT OF THE PAN PANDEMIC ON
COGNITION.
THIS IS AN ONGOING STUDY, SO
WE'LL BE ABLE TO LOOK OVER TIME
HOW THINGS HAVE CHANGED IN TERMS
OF HOW THOSE EARLY IMPACTS OF
THE PANDEMIC IMPACTED COGNITION
DOWN THE LINE AND WE'RE
INCLUDING PERFORMANCE-BASED
OBJECTIVE MEASURES FOR
PERMISSION IN A SUBSET OF THE
SAMPLE.
SO WITH THAT, I'D LIKE TO WRAP
UP BY THANKING YOU FOR BEING
PART OF THIS, AND THE
INTERNATIONAL GROUP OF
INVESTIGATORS IS VERY LARGE AND
OUR FUNDERS AT MASSACHUSETTS
GENERAL HOSPITAL COMMITTEE ON
RESEARCH, A PHILANTHROPIC GIFT
TO THE UNIVERSITY OF CALIFORNIA
SAN DIEGO WHERE I WAS WHEN I
CONDUCTED THIS WORK, AND ALSO
YOU'RE GUY
URUGUAY.
SO THANK YOU VERY MUCH AND I'LL
LEAVE IT UP TO THE NEXT
PRESENTER.
>> GREAT, THANK YOU.
I THINK I HAVE CONTROL, I
BELIEVE.
SO MY NAME IS JENNIFER FRONTERA,
AND I AM A NEUROLOGIST, I
SPECIALIZE IN STROKE AND
NEUROCRITICAL CARE, AND I ALSO
WORK CLOSELY WITH OUR
ALZHEIMER'S DISEASE RESEARCH
CENTER AT NYU ON COVID-RELATED
COGNITION.
I AM BATTLING SOMEONE ELSE WITH
THE MOUSE, BUT -- OKAY.
THESE ARE SOME DISCLOSURES.
I HAVE A VARIETY OF GRANTS AND
DIFFERENT NIH INSTITUTIONS
RELATED TO COVID AND I SIT ON
THE TASK FORCE FOR COVID-19.
THANK YOU.
I THINK I HAVE CONTROL NOW.
THANK YOU.
SO I'M GOING TO START OFF
TALKING ABOUT SOME OF THE
STUDIES WE'VE DONE AT NYU, AND
AGAIN, THERE'S AN IMMENSE
LITERATURE NOW AT THIS POINT
LOOKING AT NEUROLOGICAL EVENTS
FOLLOWING COVID, WAY TOO MUCH TO
DISCUSS IN ONE BRIEF TALK, SO
I'M JUST GOING TO FOCUS ON SOME
OF THE WORK THAT WE HAVE DONE.
SO DURING THE FIRST WAVE OF
COVID IN NEW YORK CITY, WE WERE
ABLE TO ORGANIZE A PROSPECTIVE
STUDY OF PATIENTS HOSPITALIZED
BETWEEN MARCH AND MAY AT OUR
HOSPITALS, AND WE BASICALLY
LOOKED THROUGH EVERYONE THAT WAS
TOUCHED BY A NEUROLOGY TEAM AND
IDENTIFIED PATIENTS THAT HAD IN
NEUROLOGICAL EVENTS RELATED TO
THEIR COVID ADMISSION.
THEN WE FOLLOWED THESE FOLKS OUT
AT 6 AND 12 MONTHS AND MADE
PHONE CALLS TO DO A VARIETY OF
DIFFERENT BATTERIES, CHECKING
THEIR FUNCTIONAL STATUS AND
COGNITIVE STA STATUS, AS WELLS
NEUROPSYCHIATRIC FUNCTIONING.
SO WE INITIALLY ENROLLED ABOUT
4500 PATIENTS DURING THIS
TWO-MONTH EPIC, AND WE
IDENTIFIED ABOUT 14% THAT HAD A
NEW NEUROLOGICAL DIAGNOSIS
DURING THEIR HOSPITALIZATION,
AND COMPARED THEM TO 3,885 THAT
DID NOT.
WE THEN LOOKED AT SURVIVORS
PROPENSITY SCORES.
WE HAD ABOUT 382 AT 6 MONTHS,
242 AT 12 MONTHS, AND A TOTAL OF
481 UNIQUE PATIENTS AT EITHER OF
THOSE TIME POINTS.
SO WHAT WE FOUND DURING
HOSPITALIZATION WAS THAT THE
MOST COMMON EVENT WAS REALLY
WHAT WE CALL TOXICS METABOLIC
ENCEPHALOPATHY WHICH AFFECTED
CONFUSION AND WE LOOKED AT
PATIENTS WHO WERE NOT CONFUSED
BECAUSE THEY WERE GETTING
SEDATION, THEY WERE CONFUSED
BECAUSE THEY HAD SOME FORM OF
BRAIN INJURY, EITHER DUE TO AN
INFECTION, LOW OXYGEN LEVELS,
KIDNEY FAILURE, ET CETERA, AND
THIS WAS BY FAR THE MOST COMMON
THING THAT WE OBSERVED, AND HAS
SUBSEQUENTLY BEEN OBSERVED IN
MULTIPLE OTHER COHORTS.
WE ALSO SAW ISCHEMIC STROKE,
HEMORRHAGES, SEIZURES AND A
VARIETY OF OTHER THINGS, BUT
MOSTLY DOMINATED BY THIS
ENCEPHALOPATHY OR THIS MENTAL
STATUS ABNORMALITIES.
MOST OF THESE PEOPLE DEVELOPED
THESE ACUTELY, WITHIN A COUPLE
OF DAYS OF INITIAL COVID
SYMPTOMS.
AND PEOPLE THAT DID HAVE A NEW
NEUROLOGICAL EVENT UNFORTUNATELY
HAD A MUCH HIGHER RATE OF
IN-HOSPITAL DEATH, WHICH WAS
INCREASED BY 38% COMPARED TO
THOSE WHO DID NOT.
DURING THIS INITIAL
HOSPITALIZATION, WE ALSO LOOKED
AT SOME BLOOD MARKERS OF BRAIN
INJURY.
AND WE USED SINGLE MOLECULAR
ARRAY TECHNOLOGY TO LOOK AT
THESE MARKERS TAU, MARKERS OF
NEURONAL INJURY.
THIS PHOSPHORYLATED TAU IS MORE
SPECIFIC TO ALZHEIMER'S-TYPE
PATHOLOGY.
GFAP IS A MARKER OF GLIAL CELLS
OR ASTROCYTES AND AXONAL INJURY.
PEOPLE THAT HAD TOXIC METABOLIC
ENCEPHALOPATHY OR CHANGES IN
THEIR MENTAL STATUS HAD
SIGNIFICANTLY HIGHER LEVELS OF
MANY OF THESE MARKERS, AS DID
FOLKS WHO DIED IN HOSPITAL, AND
THOSE WHO WERE ABLE TO GO HOME
HAD SIGNIFICANTLY LOWER LEVELS.
WE ALSO COMPARED LEVELS OF
BIOMARKERS TO OUR ALZHEIMER'S
DISEASE COHORT, WHO HAD DONATED
BLOOD SAMPLES IN 2019.
SO DEFINITELY WERE
COVID-NEGATIVE, AND WHO HAD BEEN
DIAGNOSED WITH EITHER MILD
COGNITIVE IMPAIRMENT OR
ALZHEIMER'S-TYPE DEMENTIA.
FOR SOME OF THESE MARKERS, YOU
CAN SEE THAT THE LEVELS WERE AS
HIGH AS IF NOT SIGNIFICANTLY
HIGHER THAN WHAT WAS OBSERVED IN
ALZHEIMER'S-TYPE PATIENTS,
INDICATING WE WERE LOOKING AT
PEOPLE WITH A PRETTY SEVERE
BRAIN INJURY.
I ALSO WANT TO MENTION WHEN WE
EVALUATED THE COVID PATIENTS, WE
EXCLUDED PEOPLE WHO HAD PRIOR
HISTORY OF DEMENTIA OR COGNITIVE
DISORDER SO WE REALLY WANTED TO
GET A SENSE OF ACUTE INJURY
HAPPENING DURING THAT
HOSPITALIZATION.
SO WE FOLLOWED THESE FOLKS OUT
AT SIX AND 12 MONTHS TO SEE WHAT
THEIR OUTCOMES WERE.
HERE'S A VARIETY OF SCALES THAT
WE KIND OF MEASURED.
MODIFIED RANKIN LOOKS AT DO YOU
STILL HAVE SYMPTOMS, CAN YOU DO
YOUR NORMAL ACTIVITY, CAN YOU
WALK, ARE YOU BED-BOUND, ET
CETERA.
AND HIGHER SCORES ARE WORSE.
BARTHEL IP DEX IS ACTIVITIES OF
DAILY LIVING, CAN YOU GO TO THE
BATHROOM BY YOURSELF, SHOWER,
COMB YOUR HAIR, GET DRESSED, ET
CETERA.
TELEPHONE MOCA IS A COGNITIVE
SCORE, PRETTY BASIC MEASURE OF
COGNITION AND THEN WE ALSO
LOOKED AT THESE SELF-REPORTED
OUTCOMES HERE.
I'LL JUST DRAW YOUR ATTENTION
TO, OVERALL, THE FACT THAT 90%
OF PEOPLE HAD AT LEAST ONE
ABNORMAL METRIC AT SIX MONTHS,
AND STILL 87% HAD AT LEAST ONE
ABNORMAL METRIC AT 12 MONTHS IF
YOU LOOK AT THE TELEPHONE MOCA
SCORES, 41% TESTED ABNORMAL AT
12 MONTHS.
THESE ARE PEOPLE THAT HAD
BASELINE AGAIN SHA OR COGNITIVE
DIAGNOSES.
THIS IS ADJUSTED FOR EDUCATIONAL
IS IT TUS.
SO SOMEWHAT PROFOUND COGNITIVE
ISSUES EVEN OUT TO 12 MONTHS.
THE GOOD NEWS, HOWEVER, WAS THAT
BETWEEN 6 AND 12 MONTHS TESTING,
WE DID SEE SIGNIFICANT
IMPROVEMENTS IN MOCA SCORES AS
WELL AS ANXIETY SCORES AND THERE
WAS GENERALLY IMPROVEMENT IN A
MAJORITY OF FOLKS FOR FATIGUE,
DEPRESSION, SELF-REPORTED
OUTCOMES.
FUNCTIONAL STATUS AND ACTIVITIES
OF DAILY LIVING ACTUALLY TENDED
TO REMAIN STATIC AND PLATEAUED
FOR MOST FOLKS, WHICH IS NOT
UNEXPECTED SINCE MOST PEOPLE
TYPICALLY MAKE THEIR MAXIMAL
SPONTANEOUS RECOVERY WITHIN 3 TO
6 MONTHS AFTER NEUROLOGICAL
INJURY AND THEN PLATEAU.
WHAT WE'RE INTERESTED IN NOW, I
THINK, IS THESE RED BARS OF
FOLKS WHO SEEM TO CONTINUE TO
GET WORSE OVER TIME, AND SO WHAT
IS DIFFERENT ABOUT THESE
PATIENTS AND WHAT CAN WE DO TO
INTERVENE IS, I THINK, AN
IMPORTANT AREA OF FOCUS RIGHT
NOW.
WE ALSO LOOKED AT SUBJECTIVE
SYMPTOMS.
50% OF PEOPLE SAID THEY STILL
HAD SYMPTOMS AT 12 MONTHS, AND
THIS IS THE WHO CHECKLIST FOR
SYMPTOMS SO THERE'S A LOT OF
STUFF COVERED HERE, BRAIN FOG
WAS REPORTED IN 20% OF PEOPLE.
AND OVERALL, STILL 70%, 71% OF
PEOPLE REPORTED MULTIPLE
SYMPTOMS.
MOST PEOPLE HAVE MORE THAN ONE.
JUST TO REMIND FOLKS THAT
SYMPTOMS ARE NOT THE SAME AS
SIGNS OR STANDARDIZED TESTING.
SO IF YOU WERE ESPECIALLY
ATTENTIVE, 40% OF PEOPLE TESTED
ABNORMAL ON A TELEPHONE MOCA BUT
ONLY 20% SAID THEY HAD BRAIN
FOG.
SOME FOLKS MAY NOT RECOGNIZE
THEY HAVE A DEFICIT, WHICH IS
NOT COMMON AMONGST DEMENTIA
PATIENTS OR PEOPLE THAT HAVE
COGNITIVE ISSUES.
I WILL SAY WE DID NOT HAVE
BASELINE COGNITIVE TESTING PRIOR
TO COVID, SO THAT'S A HUGE
LIMITATION, BUT THERE PROBABLY
IS A SUGGESTION OF THIS HERE.
AND THIS IS IMPORTANT BECAUSE IN
DESIGNING STUDIES, WE CAN'T JUST
ENROLL PATIENTS THAT HAPPEN TO
SAY THEY HAVE SYMPTOMS.
THERE HAS TO BE OTHER CRITERIA
FOR ENROLLMENT BECAUSE SOME
PEOPLE MAY NOT RECOGNIZE
DEFICITS AND STILL, THOSE ARE
FOLKS THAT REALLY NEED TO BE
INCLUDED IN STUDIES.
THESE SYMPTOMS THAT PEOPLE HAD
WERE IMPORTANT.
45% OF PEOPLE SAID THEY COULDN'T
WORK TO THE DEGREE THEY HAD
PRIOR TO BEING HOSPITALIZED FOR
COVID.
THEY COULDN'T DO HOUSEHOLD
RESPONSIBILITIES OR LEISURE
ACTIVITIES, AND THIS WEEK, THERE
WAS A REPORT FROM THE BROOKINGS
INSTITUTE ESTIMATING THAT
16 MILLION AMERICANS HAVE LONG
COVID, AND THEN 2 TO 4 MILLION
OF THESE MAY BE UNABLE TO WORK
DUE TO COVID AND THIS WOULD
TRANSLATE INTO LOST WAGES OF 17,
SO THAT'S A SUBSTANTIAL IMPACT,
AND I THINK LONG COVID IS GOING
TO BE WITH US FOR A WHILE AS AN
AREA OF INTEREST FOR STUDY.
NOW I MENTIONED THAT 70% OF
PEOPLE AT LEAST IN OUR COHORT
HAD A LOT OF DIFFERENT SYMPTOMS.
IS EVERYBODY WITH LONG COVID THE
SAME?
NO.
AND I THINK WE DID A
HIERARCHICAL CLUSTER ANALYSIS ON
SUPERVISED STATISTICAL ANALYSIS
TRYING TO GROUP THESE FOLKS
TOGETHER TO SEE IF THERE'S
DIFFERENT TYPES OF PEOPLE WITH
LONG COVID.
WE CAME UP WITH THREE GROUPS.
ONE WITH FEW SYMPTOMS, ONE WITH
A HANDFUL OF SYMPTOMS AND THEN
ONE WITH A LOT OF SYMPTOMS.
THE FIRST GROUP, YOU KNOW, NOT
TOO MUCH GOING ON, THEY
COMPLAINED OF HEADACHE
PRIMARILY.
THE SECOND GROUP WAS A LITTLE
OVER HALF THE PEOPLE, THEY HAD
USUALLY ABOUT THREE SYMPTOMS,
SHORTNESS OF BREATH, HEADACHE
AND BRAIN FOG WERE THE MOST
COMMON.
AND THEN THERE WAS A MINORITY OF
PATIENTS THAT HAD MULTIPLE
SYMPTOMS.
MEDIAN OF 16 DIFFERENT SYMPTOMS.
THIS GROUP HAD PROMINENT ANXIETY
AND DEPRESSION, THEY HAD A
GREATER NUMBER OF LIFE
STRESSORS, WHICH IS RELATED
SOMEWHAT TO THE LAST TALK, AND
THEY WERE SICKER, THEY WERE MORE
OFTEN MECHANICALLY VENTILATED
DURING THEIR INDEX
HOSPITALIZATION.
WE ALSO LOOKED AT THERAPEUTIC
INTERVENTIONS THAT WERE APPLIED
TO THESE CLUSTERS, AND YOU KNOW,
NOT SURPRISINGLY, PATIENTS WITH
FEW SYMPTOMS WERE LESS LIKELY TO
RECEIVE INTERVENTIONS BUT A
SUBSTANTIAL PROPORTION DID
IMPROVE WITH WHATEVER THEY
RECEIVED.
IN THE MIDDLE GROUP, PHYSICAL
AND OCCUPATIONAL THERAPY WERE
COMMON AND A LOT OF PEOPLE
IMPROVED.
AND IN THIS LAST GROUP, WHICH IS
THE SICKEST GROUP, NOT JUST BY
SYMPTOMS BUT THEY ALSO HAD WORSE
FUNCTIONAL MODIFIED RANKIN
SCORES AND THEN WORSE REPORTED
METRICS FOR ANXIETY, DEPRESSION,
FATIGUE AND SLEEP.
THESE FOLKS WERE MORE LIKELY TO
RECEIVE SOME SORT OF PSYCHIATRIC
TREATMENT, WHETHER IT WAS TALK
THERAPY OR MEDICAL INTERVENTION,
AND FORTUNATELY 100% REPORTED
SOME DEGREE OF IMPROVEMENT.
IT'S A SMALL N, ONLY 2200
PEOPLE, BUT I WANT TO BRING THIS
TO LIGHT JUST BECAUSE I THINK
IT'S IMPORTANT TO TAKE A
HOLISTIC APPROACH IN RECOGNIZING
NOT EVERY COVID PATIENT IS THE
SAME, AND THAT NEUROPSYCHIATRIC
INTERVENTIONS SHOULD BE
CONSIDERED AND APPLIED AS
APPROPRIATE IN SORT OF A
HOLISTIC APPROACH FOR THESE
FOLKS.
WE ALSO LOOKED AT PREDICTORS OF
OBJECTIVE AND SUBJECTIVE
OUTCOMES, AND REALLY THERE WERE
FIVE MAIN ONES THAT CAME UP.
THESE HAVE BEEN SORT OF SEEN IN
DIFFERENT COHORTS AS WELL AS
OURS, NOT SURPRISINGLY, OLDER
FOLKS HAD WORSE FUNCTIONAL
OUTCOMES, ACTIVITIES OF DAILY
LIVING, WORSE COGNITIVE STATUS
AND HIGHER RATES OF DEPRESSION,
SUBJECTIVE DEPRESSION.
BASELINE DISABILITY WAS -- IF
YOU'RE DISABLED AT BASELINE YOU
WERE EVEN MORE DISABLED
AFTERWARDS, WHICH IS KIND OF
INTUITIVE, AND THEN LIFE VERY
STRESSORS, WHAT WE LOOKED AT
WERE 13 DIFFERENT STRESSORS
SIMILAR TO WHAT DR. MARQUINE WAS
DISCUSSING.
WE LOOKED AT FINANCIAL
INSECURITY, FOOD INSECURITY,
SOCIAL ISOLATION, RELATIONSHIP
DIFFICULTIES AT HOME, EDUCATION
DISRUPTION, DOMESTIC VIOLENCE,
ET CETERA.
AND THESE STRESSORS ACTUALLY HAD
HIGHER ODDS RATIOS OR ADJUSTED
ODDS RATIOS FOR PREDICTING WORSE
OUTCOMES THAN ALMOST ANY OF
THESE OTHER PREDICTORS I'M
SHOWING YOU HERE.
THIS WAS ACROSS A SPECTRUM OF
DIFFERENT OUTCOMES, INCLUDING
SUBJECTIVE SYMPTOMS.
COVID SEVERITY AS IN MANY
COHORTS ALSO AFFECTS
NEURODEVELOPMENT OF POST-ACUTE
SYMPTOMS AND ACTIVITIES OF DAILY
LIVING.
OUR COHORT, SOME MIGHT CONSIDER
ALL OF THEM TO BE SEVERE BECAUSE
THEY'RE ALL HOSPITALIZED, BUT
WHEN WE SAY SEVERITY HERE, WE'RE
TALKING ABOUT REQUIRING
MECHANICAL VENTILATION.
BUT CERTAINLY COVID SEVERITY IS
A DRIVER OF POST-ACUTE SEQUELAE.
LAST I'M JUST GOING TO SHOW YOU
THIS, THIS IS A HEAT MAP.
DON'T LOOK AT THE NUMBER, NT
THIS IS LOOKING AT THOSE SAME
BIOMARKERS I SHOWED YOU EARLIER.
GREEN MEANS THERE'S STRONG OR
SIGNIFICANT ASSOCIATION.
YOU CAN SEE SOME OF THESE
BIOMARKERS DO LIGHT UP IN TERMS
OF MATCHING UP WITH OUTCOMES AT
6 MONTHS AND 12 MONTHS, AND THIS
IS A VERY SMALL SAMPLE SIZE.
SO YOU HAVE TO TAKE THIS WITH A
LITTLE BIT OF A GRAIN OF SALT.
BUT WE DID FIND THAT NFL WAS
ASSOCIATED WITH SIGNIFICANTLY
HIGHER RISK OF DEATH OR SEVERE
DISABILITY AFTER ADJUSTING FOR
OTHER FACTORS.
THAT'S KIND OF INTERESTING
BECAUSE WE'RE ALL IN SEARCH OF A
BRAIN TROPONIN AND THERE'S OTHER
STUDIES ALSO SUGGESTING THAT NFL
MIGHT BE A GOOD BIO MARKER.
AND LASTLY, I'M JUST GOING TO
SAY WE HAVE A FEW STUDIES GOING
ON NOW.
WE HAVE AN R01 THAT I AM
PARTICIPATING IN AS A P.I. WITH
PEOPLE AT OUR ADRC,
DR. WISNIEWSKI AND OUR
NEURORADIOLOGY GROUP WITH
DR. GI.
WE'RE PARTICULARLY LOOKING AT
KIND OF APPLYING THE VIRAL
THEORY OF ALZHEIMER'S TO POST
COVID AND LOOKING AT HOW
HYPOXIA, LOW OXYGEN LEVELS,
INFLAMMATION, CAN CONTRIBUTE TO
A CASCADE OF INJURY THAT COULD
LEAD TO BUILDUP OF AMYLOID BETA
AND NEUROFIBROID TANGLES IN THE
BRAIN.
>> DR. FRONTERA, I THINK WE'RE
GOING TO NEED TO MOVE TO YOUR
LAST SLIDE.
>> OKAY.
SURE.
I'LL JUST SKIP QUICKLY THROUGH
THIS, BUT IF ANYONE IS
INTERESTED, WE DO HAVE AN
NINDS-FUNDED DATA BIOBANK WHERE
WE'RE LOOKING AT ACUTE AND
POST-ACUTE NEUROLOGICAL
OUTCOMES, AND THEN OF COURSE
THERE'S THE RECOVER PROJECT,
WHICH IS A LARGE $1.2 BILLION
PROJECT LOOKING AT POST COVID
ACROSS THE LIFE SPECTRUM.
AND SO JUST TO WRAP UP, YOU
KNOW, THERE'S A CONCERN ABOUT
NEURODEGENERATION AND ACUTE
BIOMARKERS IN THE ACUTE PHASE,
AND WE STILL SEE A LOT OF
DISABILITY EVEN OUT TO 6 AND 12
MONTHS IN THESE FOLKS.
THOUGH THERE IS SOME IMPROVEMENT
IN COGNITIVE SCORES OVER TIME.
LIFE STRESSORS ARE REALLY
IMPORTANT, AS ARE SOME OF THE
OTHER PREDICTORS THAT WE EXPECT,
BUT THEY SHOULD BE CONSIDERED
AND ADDRESSED.
AND THERE'S SOME ONGOING STUDIES
THAT ARE SUPPORTED BY THE NIH
THAT HOPEFULLY WILL HELP US
DISENTANGLE WHAT'S HAPPENING
WITH POST COVID.
I'D LIKE TO THANK THE HUGE TEAM
THAT SUPPORTED THIS WORK, AND
THANK EVERYBODY FOR THEIR TIME.
>> OKAY.
THANK YOU, DR. FRONTERA.
SO DO I HAVE CONTROL OF THE
SCREEN NOW?
MY NAME IS DR. JAMES NOBLE,
NEUROLOGIST AT COLUMBIA
UNIVERSITY IRVINGTON MEDICAL
CENTER.
I'M THE CLINICAL LEADER OF OUR
ALZHEIMER'S DISEASE RESEARCH
CENTER AND FOCUS PRIMARILY ON
COGNITIVE DISORDERS OF AGING.
I'M GOING TO BE PRESENTING TODAY
TO YOU SOME OF THE THINGS THAT
ARE REALLY SERVING IN COMPLEMENT
TO THE PRIOR SPEAKERS, AND
TRYING TO SHARE WITH YOU WHAT WE
LEARNED AS WE WERE REALLY IN THE
MIDST OF THE COVID FIRST WAVE,
AND TRANSLATING THOSE FINDINGS
INTO NOW WHAT WE ARE REALLY
INTERESTED IN, WHICH ARE
LONGITUDINAL STUDIES OF
COGNITIVE AGING.
WHAT DOES IT MEAN TO HAVE HAD
COVID BOTH IN THE INITIAL WAVES
AND SUBSEQUENT TIMES.
SO I WANT TO THANK THE
ORGANIZERS AND THE SUPPORT I'VE
RECEIVED PREVIOUSLY.
HERE ARE MY DISCLOSURES,
PRIMARILY RELATED ONES ARE THE
NIH GRANT SUPPORT THAT I RECEIVE
WHICH IN PART HAS FUNDED SOME OF
THIS WORK.
TODAY WE'RE GOING TO BE
REVIEWING AS I SAID THE
EXPERIENCES WE HAD AT OUR
CENTER, THE EPIDEMIOLOGY
DEMENTIA RELATED TO COVID
SYMPTOMS AND MORTALITY THAT WE
FOUND AT OUR CENTER DURING THE
FIRST NEW YORK CITY WAVE, AND
HOW WE'VE THOUGHT ABOUT THAT AS
EVOLVING CONCEPTS AND
COMPLICATIONS HAVE EMERGED,
INCLUDING LONG COVID BUT ALSO
BALANCING THAT AGAINST NEW
TREATMENTS AND VACCINATION
STRATEGIES THAT HAVE EMERGED
SIMULTANEOUSLY.
AND ALSO HOW DO WE PUT ALL OF
THAT TOGETHER AND BEGIN TO
LEVERAGE WHAT EXISTING STUDIES
WE HAVE TO BETTER UNDERSTAND THE
IMPACTS OF COVID ON AGING
POPULATIONS, ESPECIALLY THOSE
WHO ARE AT RISK OF OR WHO
ALREADY HAVE DEMENTIA AND OTHER
COGNITIVE DISORDERS.
SO JUST TO REFLECT ON WHERE WE
GOT STARTED, IT'S HARD TO
BELIEVE THAT JUST 2 1/2 YEARS
AGO, THE WORLD WAS SO DIFFERENT
BUT IT WAS, AND AT THE TIME,
JUST BEFORE THE PANDEMIC HIT, WE
IN OUR PRACTICE HAD 13
CLINICIANS INCLUDING EIGHT
FACULTY, THREE FELLOWS AND A
NURSE PRACTITIONER, AND THAT S
LARGELY BEEN OUR SETUP EVER
SINCE AND OUR PRACTICE IS VERY
LARGE, WE SEE SOMEWHERE BETWEEN
800 AND 1,000 NEW INDIVIDUALS
WITH COGNITIVE CONCERNS AND TWO
TO 3,000 FOLLOW-UPS ANNUALLY.
WE SERVE PRIMARILY THE RESIDENTS
OF NORTHERN MANHATTAN, INCLUDING
WASHINGTON HEIGHTS AND THE
SOUTHWEST BRONX.
AND WE HAVE ALSO A LARGE
REFERRAL BASIS FROM THE
TRI-STATE AREA.
WE WERE ENTIRELY IN-PERSON
THROUGH FEBRUARY 2020.
WE ALSO HAVE AT OUR CENTER THE
BENEFIT OF A LARGE RESEARCH
PORTFOLIO TRYING TO HELP US
UNDERSTAND NORMAL COGNITIVE
AGING BOTH IN COMMUNITY COHORTS
AS WELL AS THOSE PERSONS WHO ARE
AFFECTED BY DEMENTIA AND
ENROLLED IN LARGE TRIALS.
AND WE ARE ALSO SUPPORTED BY A
PROGRAM WHICH IS RELATIVELY
AGNOSTIC TO INSURANCE STATUS,
NOT JUST PATIENTS WITH YOU O
EDUCATE OTHER CAREGIVERS AND
CLINICIANS IN THE COMMUNITY.
AND JUST TO REFLECT ON THE
SPECIFIC EXPERIENCE OF NEW YORK,
HERE WE ARE WITH THE WAVES AS
HAVE BEEN SEEN MANY TIMES.
THESE ARE FROM THE JOHNS HOPKINS
DASHBOARDS THAT ARE CURRENTLY
AVAILABLE AND WE'RE PROBABLY ALL
FAMILIAR WITH, BUT JUST TO KIND
OF REFLECT ON WHAT NEW YORK'S
EXPERIENCE WAS, WE WERE REALLY
IN THE CENTER OF A LOT OF
EMERGING AND NEW CONCERNING
DATA, WE'RE VERY CONCERNED ABOUT
WHAT OUR PATIENTS' WELL-BEING
WAS, AND THIS REALLY BEGAN IN
EARLY MARCH.
AND THAT ALSO, I WANT TO PUT IN
CONTEXT TO THE REMAINDER OF THE
UNITED STATES, WHICH HAS REALLY
HELPED US THINK ABOUT NATIONALLY
WHEN WE THINK ABOUT ALZHEIMER'S
RESEARCH STRATEGIES ON A
NATIONAL LEVEL, THAT WHAT FITS
FOR NEW YORK DOES NOT FIT FOR
EVERYBODY ELSE.
THE TIMING OF WHAT WE
EXPERIENCED WAS VERY DIFFERENT
THAN WHAT THE REMAINDER OF THE
COUNTRY EXPERIENCED, AND OFTEN
WE WERE KIND OF THE LEADING EDGE
OF THOSE THINGS.
BACK ON MARCH 2ND, 2020, WE HAD
THE FIRST CASE THAT WAS
HOPTDIZED
HOSPITALIZED AT COLUMBIA, THE
FIRST CASE DIAGNOSED A DAY OR
TWO BEFORE AT ANOTHER CENTER BUT
WE HAD THE FIRST HOSPITALIZED
PATIENT HERE, WITHIN TWO WEEKS,
BASICALLY EVERYTHING SHUT DOWN.
ALL OF OUR RESEARCH REALLY CAME
TO A HALT.
THE NEXT STEP WE HAD ABOUT THREE
MONTHS LATER SOME RESEARCH
RESUMED, PRIMARILY REMOTE BUT
SOME INPATIENT WORK, IN-PERSON
WORK.
SCHOOLS RE-OPENED SIX MONTHS
LATER ON A DELAYED TIMELINE, AND
THEN WE BEGAN TO HAVE THE
VACCINATIONS AVAILABLE REALLY
JUST BEFORE MID DECEMBER IN
2020.
AGAIN THE TIMELINE IN THE
REMAINDER OF THE COUNTRY WAS
QUITE DIFFERENT.
THERE WERE LAGS WITH FIRST WAVES
AND SECOND WAVES LOOKING VERY
DIFFERENT THAN WHAT WE
EXPERIENCED IN NEW YORK, AND
JUST TO GIVE YOU A SENSE, THESE
ARE DIFFERENT SCALES HERE, BUT
THE RELATIVE WAVES ARE IMPORTANT
TO UNDERSTAND THAT NOT
EVERYTHING LINED UP.
AS HAS BEEN SHARED FROM SOME OF
THE OTHER INVESTIGATORS HERE
TODAY, WE REALLY HAD TWO KIND OF
CALLS THAT WE RECEIVED IN OUR
PRACTICE, WHICH HAVE EVOLVED
INTO KIND OF OUR OWN RESEARCH
EXPERIENCE AND THE INTERESTS
THAT WE HAD.
ONE WAS WE WERE SEEING DELIRIUM
IN PERSON WITH POSSIBLE COVID
SYMPTOMS AT A TIME WHEN IT WAS
VERY DIFFICULT TO GET A TEST AND
FAMILIES WERE FEARFUL OF COMING
TO HOSPITALS BECAUSE OF REALLY
DISSOCIATIONS, THEY WERE UNABLE
TO SEE THEIR FAMILY MEMBERS WHEN
HOSPITALIZED.
ALSO WITH LOCKDOWN POLICIES,
FAMILIES WERE FACING FLU NEW
CAREGIVER ROLES, NOT THE ILLNESS
OF COVID BUT EVERYTHING ELSE
THAT WENT ALONG WITH IT.
SO OUR RESEARCH QUESTIONS WERE
IS DELIRIUM A RECOGNIZED SYMPTOM
IN COVID AND IS COVID MORE
DEADLY TO OUR PATIENTS, IT STILL
REMAINS A SERIOUS CONCERN, AND
AGAIN WE HAD THESE RELUCTANCES,
THESE CHALLENGES THAT WE WERE
FACING IN COUNSELING OUR
FAMILIES.
WE ALSO BEGAN TO WONDER WHAT ARE
THE IMPACTS OF THIS ON OUR
CAREGIVING AND WHAT WERE THE
LONG TERM SEQUELAE EVEN BEFORE
WE WERE THINKING ABOUT POST
COVID SYNDROME, WE WERE WORRIED
ABOUT WHAT ARE THE LONG-TERM
IMPACTS OF THIS PROBLEM ON BRAIN
HEALTH.
LIKE DR. FRONTERA, WE TOOK A
LOOK AT OUR INPATIENT
POPULATION, AND WE WERE ABLE TO
LOOK AT ALL CASES AGE 65 AND UP
BETWEEN MARCH AND APRIL OF 2020
AND PUBLISHED THIS WITH A GROUP
OF COLLEAGUES AND JOURNAL OF
ALZHEIMER'S DISEASE IN MAY OF
2021.
WHAT WE FOUND BASICALLY WAS THAT
FOR THE MOST PART, THE SYMPTOMS
WE SAW IN OLDER INDIVIDUALS WITH
OR WITHOUT DEMENTIA WERE LARGELY
THE SAME WE SAW WITH THE GENERAL
POPULATION, WITH COUGH AND FEVER
BEING VERY COMMON, BUT WE SAW
SOME THINGS THAT WERE LESS
COMMON, LIKE DYSPNEA, DIARRHEA,
MUSCLE PAINS, CHILLS.
WE ALSO SAW CONFUSION WAS VERY
COMMON.
SUGGESTING THAT THERE IS
DELIRIUM ASSOCIATED WITH COVID
AS WE WERE SUSPECTING BUT
PERHAPS AN UNDERREPORTING,
PERHAPS RELATED TO THOSE WHO HAD
DEMENTIA NOT BEING AWARE OF
THEIR SYMPTOMS OR NOT
REMEMBERING TO REPORT THEIR
SYMPTOMS OR MAYBE A DIFFERENT
EXPERIENCE ALL TOGETHER.
SO WE FOUND THAT PERSONS WITH
DEMENTIA WERE THREE TIMES MORE
LIKELY TO PRESENT WITH DELIRIUM,
BUT THEY LESS OFTEN PRESENTED
WITH OTHER COVID SYMPTOMS AND IT
WAS ASSOCIATED, DEMENTIA WAS
ASSOCIATED WITH A HIGHER
MORTALITY BUT NOT OF A TAKING
INTO ACCOUNT OTHER COMORBIDITIES
AND AGE.
CODE STATUS WAS ALSO STRONGLY
ASSOCIATED WITH MORTALITY BUT
DID NOT SIGNIFICANTLY ATTENUATE
WITH OUR OTHER PREDICTORS.
THE LIMITATIONS WE RECOGNIZED,
IT WAS A SINGLE CENTER, CHART
ANALYSIS AND POSSIBLE BIAS OF
REPORTING, FOR GETTING.
OBVIOUSLY SINCE THEN, VACCINES
AND VARIANTS HAVE COME ALONG.
SO WE STARTED TO WONDER,
FINDINGS BY THE TIME WE'RE
REALLY ASIM LIGHT LATHING THAT
INFORMATION, WERE THE FINDINGS
WE HAD IN THE FIRST NEW YORK
CITY WAVE REALLY RELEVANT TO THE
NEXT NEW YORK CITY WAVE AND HOW
DID THEY RELATE TO THE FIRST
TRUE WAVE ACROSS THE UNITED
STATES?
SO THERE HAVE BEEN A LOT OF
CONCEPTS AROUND COVID-19 THAT
WE'VE BEEN THINKING ABOUT AND
EXPERIENCING OURSELVES.
AS WE ALL KNOW, THERE ARE
DIFFERENT VARIANTS, SO MANY
VARIATIONS TO THE PANDEMIC.
WE'VE HAD NEW VARIANT OF THE
DISEASE ITSELF, NEW
COMPLICATIONS, NEW RECOVERY
PATHWAY, AND A LOT OF THESE HAVE
BEEN REFLECTED EITHER THROUGH
THE COURSE OF EITHER NATURAL
IMMUNITY THROUGH EXPOSURE AND
ILLNESS, BUT ALSO NEW TREATMENTS
AND NEW VACCINES THAT HAVE COME
ALONG AND EVEN JUST THIS WEEK,
THE NEW BOOSTER IS ROLLING OUT.
WE'VE ALSO HAD DIFFERENT TIMING
AS I'VE MENTIONED SEVERAL TIMES
ALREADY, BETWEEN OUR AREA AND
OTHER LOCALITIES, AS WELL AS THE
NATION'S EXPERIENCE WITH IT.
AS I SAID BEFORE, THERE WERE
CO-OCCURRING FACTORS, NOT JUST
THE PSYCHOSOCIAL STRESS OF THE
PANDEMIC AND THE INITIAL
LOCKDOWNS ASSOCIATED WITH IT,
BUT OTHER UNIQUE SOCIAL
STRESSORS OCCURRING IN PARALLEL
THROUGHOUT THE UNITED STATES.
SO WHAT WE REALLY STARTED TO
UNDERSTAND IS, WE NEED TO
UNDERSTAND THE IMPACT OF COVID
ON A LARGE SCALE, SO MANY
CHANGES IN DISEASE,
HETEROGENEOUS EXPERIENCES AND
WHENEVER POSSIBLE LEVERAGE
EXISTING LARGE STUDIES ON AGING
TO HELP US IDENTIFY THE
TRAJECTORIES.
SO AS THE CLINICAL CORE LAY TORE
OF OUR ALZHEIMER'S CENTER I SEE
NO BETTER OPPORTUNITY THAN
REALLY OUR EXPERIENCE WITH THE
EDRCs, THE NATIONAL
ALZHEIMER'S COORDINATING CENTER.
THERE ARE NOW ABOUT 40 CENTERS
NATIONWIDE, FOLLOWING ABOUT
45,000 PARTICIPANTS OVER TIME.
SOME HAVE NOT BEEN SEEN FOR A
LONG WHILE BUT MANY ARE STILL
ACTIVELY BEING FOLLOWED AND
BASICALLY ERCH IN THIS EN
ANNUALLY, ALMOST ALL ARE AGE 60
AND ABOVE AND MOST ARE OLDER
THAN THAT, AND WE SEE A RANGE OF
COGNITIVE DIAGNOSES FROM NORMAL
TO PERSON WITH DEMENTIA IN MANY
CENTERS BUT NOT ALL, BLOOD WORK
AND GENETICS AND IMAGING.
IN COVID, WE BEGAN ASSESSING THE
IMPACT WITHIN THIS COHORT BACK
IN JUNE OF 2020, BUT THAT FORM
THAT WE USE WAS AT A TIME BEFORE
POST COVID SYNDROME HAD BEEN
DESCRIBED AND BEFORE ALL OF THE
MAJOR PSYCHOSOCIAL DISSTRESSORS
HAD REALLY BECOME APPARENT IN
THE POPULATION AND BEFORE WE
REALLY HAD RECOGNITION OF
RECURRING INFORECASTS WITH
COVID, BEFORE VACCINES AND
TREATMENTS, AND WE STARTED
REALIZING THAT THIS PANDEMIC
CLEARLY WAS NOT GOING TO RESOLVE
WITHIN A YEAR, BUT THAT WAS HOW
THE FORM WAS LARGELY CONSTRUCTED
AT THE TIME.
THOSE WERE THE PRESUMPTIONS.
SO HERE IS WHAT HE WE WE .
THE FIRST YEAR'S EXPERIENCE WITH
THIS FORM, THAT FIRST YEAR
REALLY PREDATES MOST OF THE
CASES WITHIN THE UNITED STATES,
BUT IT WAS TELLING, WHAT WE DID
LEARN.
THIS IS ACTUALLY THIS GRAPHIC AT
THE RIGHT WAS REALLY MORE CLOSER
TO 3500 FORMS THAT WERE
COMPLETED OVER THE COURSE OF
ABOUT A YEAR AND A HALF, BUT
LARGELY WHAT WE SAW IN THE FIRST
YEAR.
THAT IS THAT WE SAW FAR MORE
PEOPLE BEING TESTED THAN WERE
SICK.
WE SAW RELATIVELY SMALL NUMBER
OF INDIVIDUALS WHO WERE
HOSPITALIZED WITH COVID AND THEN
CAME BACK TO BE SEEN.
WE SAW A LOT OF PEOPLE WHO HAD
COGNITIVE CHANGES.
SO AGAIN, THIS IS SOMETHING
THAT'S HAPPENING IN PARALLEL TO
COGNITIVE AGING, BUT ALSO THE
OTHER DISTRESSORS HAPPENING IN
THE PERSON'S LIVES.
AS THIS FORM WAS ROLLING OUT,
INSTEAD OF THAT ONE-YEAR KIND OF
TIME LOCKED ASSESS M, WE WANTED
TO BETTER UNDERSTAND WHAT WERE
THE SUMMIT OF EXPERIENCES OF
PERSONS FOR WHAT WAS REALLY A
BRIEF ILLNESS FOR MOST
POTENTIALLY RECURRING FOR SOME
AND ALL THE WHILE, THEY'RE
RAPIDLY EVOLVING PROBLEM ACROSS
THE UNITED STATES.
SO I'VE BEEN CO-LEADING AN
INITIATIVE WITH SEVERAL OTHERS
AT OTHER ADRCs TO RE-THINK AND
ACTUALLY REDEPLOY A NEW COVID
IMPACT FORM RE NIEZING IN E
HAD MYRIAD STUDIES THAT HAVE
SUPPORTED THAT SEEMS TO BE THAT
COVID-19 FOR SOME SERVES AS AN
INFLECTION POINT FOR CLINICAL
DECLINE, AND THERE ARE SOME
STUDIES THAT HAVE SUGGESTED IN
ADDITION TO DR. FRONTERA'S THAT
PLASMA BIOMARKERS AND MRI
CHANGES EVOLVE RELATIVE TO
SOMEBODY'S EXPERIENCE WITH
COVID-19.
WE REALLY HAVE AN UNMATCHED
OPPORTUNITY FOR STUDY ACROSS
THESE 40 CENTERS, BETWEEN NOT
JUST HAVING A NATIONWIDE STUDY
BUT A REPRESENTATIVE STUDY FOR
MANY WHO ARE UNDERREPRESENTED IN
RESEARCH, AND WE REALLY HAVE
PRIMARY GOALS OF THIS UPDATED
FORM TO CAPTURE INFORMATION TO
INFORM KEY SCIENTIFIC QUESTIONS
REALLY ABOUT THE BIOLOGICAL
IMPACT OF COVID-19.
BOTH THE IMMEDIATE AND LONG TERM
SEQUELAE, REFLECTING ON
TREATMENTS THAT HAVE EVOLVED
OVER THAT TIME, IMPACT OF
VACCINATION, AND UNDERSTANDING
THAT THE TIMING AND TYPE OF
VACCINATION AND THE TIMING OF
INFECTION MAY ALSO MATTER.
AND TO THAT POINT, WE'RE GOING
TO TRY TO CAPTURE NOT THE
STRAINS NECESSARILY BECAUSE
PEOPLE DON'T OFTEN KNOW, BUT THE
TIMING OF THEIR INFECTION CAN
INFORM MAYBE WHAT STRAIN OR WHAT
SEVERITY THEY MAY HAVE
EXPERIENCED IN ADDITION TO THE
LEVEL OF CARE THAT THEY
RECEIVED.
AND THIS IS USED IN CONJUNCTION
REALLY TO DOVETAIL IN WITH OTHER
EXPERIENCES THAT WE HAVE ONGOING
IN THE NACC AND THE NATIONAL
ALZHEIMER'S COORDINATING CENTER
TO FURTHER UNDERSTAND NOT JUST
THE CLINICAL BURDEN AND
NEUROPSYCHOLOGICAL IMPACTS, BUT
UNDERSTAND WHAT HEALTHCARE
UTILIZATION TOOK PLACE OVER THAT
SAME TIME.
SO THIS IS A WORK IN PROGRESS.
WE HOPE TO BE ABLE TO REPORT OUT
SOME FINDINGS WITHIN THE NEXT
YEAR OR SO ABOUT WHAT THAT
SUPPLETIVE EXPERIENCE WAS IN
THIS COHORT AND I LOOK FORWARD
TO SHARING IT POTENTIALLY WITH
YOU THEN.
IF YOU HAVE ANY QUESTIONS,
PLEASE FEEL FREE TO REACH OUT.
THANK YOU, JAMES.
I'M GOING TO TALK ABOUT THE
IMPACT OF COVID BOTH ON NURSING
HOMES, BUT ALSO LONG-TERM CARE
SETTINGS.
THERE WILL BE SOME OVERLAP.
MY ONE MAJOR CONFLICT OF
INTEREST THAT I'M STILL DOING IN
MY RETIREMENT IS WE'RE
DEVELOPING COMPUTERIZED PROGRAMS
FOR OLDER PEOPLE TO DO GOOD
EVALUATIONS AS OPPOSED TO WHAT
TENDS TO HAPPEN.
I WANT TO POINT OUT THAT ALL THE
RAPID SCREENS THAT WE'VE
DEVELOPED AT ST. LOUIS
UNIVERSITY ARE IN THE PUBLIC
DOMAIN AND CAN BE USED BY
ANYONE.
THERE IS NO COST TO THEM, WHICH
IS IMPORTANT.
I CAN'T GET MY SLIDES TO GO
FORWARD.
OKAY.
SO THIS IS LONG COVID SYNDROME.
HERE IS A NATIVE AMERICAN WOMAN
SAYING, SEEMS LIKE IT'S BEEN A
LONG JOURNEY AND A LARGE TWO
MONTHS OF RECOVERY.
I'M MAKING PROGRESS AND STARTING
TO WALK INDEPENDENTLY WITH A
CANE.
A LITTLE AT A TIME, BUT GETTING
THERE.
WHEN WE LOOK AT COVID-19 AND
MORTALITY, WE HAVE TO REALIZE
THAT THE UNITED STATES HAS DONE
PRETTY TERRIBLY, AS AS U.K.,
ITALY, AND OBVIOUSLY SOME OF THE
SOUTH AMERICA COUNTRIES COMPARED
TO OTHERS.
I WOULD LIKE TO STRESS THAT IF
YOU LOOK AT SINGAPORE AND
TAIWAN, WHERE FUNDAMENTALLY
UTILIZATION OF MASKS IS A NORMAL
BEHAVIOR WHEN THEY HAVE
INFECTIONS IN THE COMMUNITY HAVE
DONE REMARKABLY WELL, AND I WILL
KEEP ON POINTING OUT THAT THE
SCIENCE TRULY CONFIRMS THAT THE
USE OF MASKS IS IMPORTANT, AND
MOST PROBABLY AS IMPORTANT AS
VACCINES.
SO I NEED TO SAY THIS BECAUSE
WE'VE MOVED INTO AN ERA WHERE
PEOPLE DON'T SEEM TO THINK MASKS
ARE THAT IMPORTANT.
AS HAS BEEN POINTED OUT BY
OTHERS, THE PEOPLE WHO TEND TO
DIE ARE THE OLDER PEOPLE.
WHEN WE LOOK AT COVID-19 IN
NURSING HOMES, MANY NURSING
HOMES HAVE HAD MULTIPLE
OUTBREAKS, WEEKS OF SUSTAINED
TRANSMISSION OVER THE PERIOD OF
TIME, AND SOME NURSING HOMES ARE
UP TO THEIR FOURTH OUTBREAK AT
THIS STAGE, AND SOME OF THESE
OUTBREAKS ARE SHORT, SOME OF
THEM ARE LONG.
AND THIS SLIDE SHOWS WHAT I
THINK WE ALL KNOW, THAT COVID
COMES IN SORT OF BURSTS, THAT
WHERE YOU HAVE THESE BURSTS,
DEATHS TEND TO GO UP.
THE MOST RECENT BURST, WHICH HAS
BEEN TAKING PLACE TOWARD THE END
OF AUGUST, BEGINNING OF
SEPTEMBER, APPEARS TO BE
ASSOCIATED WITH LESS DEATH THAN
THE OTHERS.
THIS IS PARTICULARLY TRUE AT
NURSING HOMES, WHERE WE HAVE HAD
MUCH MORE VACCINATION.
SO IF YOU LOOK AT IT IN A
NURSING HOME, BASICALLY THE CDC
AND CMS SAID THAT WE NEEDED TO
GET EVERYBODY VACCINATED, AND WE
GOT ABOUT 87% OF RESIDENTS
VACCINATED WITH THEIR PRIMARY
VACCINATION, BUT AT THE MOMENT,
ONLY 56% OF RESIDENTS ARE
UPDATED.
THIS IS A PROBLEM.
IF YOU DON'T GET THE BOOSTERS,
IT APPEARS THAT THE VACCINATION
IS A LITTLE BIT LIKE THE FLU
VACCINATION.
IT WORKS FOR A SHORT PERIOD OF
TIME, AND THEN IT DISAPPEARS.
THE OTHER PROBLEM IS STAFF
ORIGINALLY WELL VACCINATED BUT
STAFF ARE NOT FOLLOWING UP WITH
VACCINATIONS, AND WHEN WE LOOK
AT THE CONFIRMED CASES, WE HAVE
OVER A MILLION CONFIRMED
RESIDENT CASES OF COVID WITH
ABOUT 155,000 DEATHS, AND STAFF,
ALSO VERY HIGH NUMBERS, THOUGH
MUCH LOWER DEATH RATE WAS IN THE
STAFF.
I PUT THIS IN BECAUSE I THINK
THIS SAYS WHAT I WANT TO SAY.
I HAVE, AS FAR AS I KNOW, NOT
HAD COVID.
I AM FULLY VACCINATED BUT ALSO
MY WIFE AND I WEAR MASKS
WHENEVER WE GO OUT IN PUBLIC.
AND MY DOGS, I HAVEN'T MANAGED
TO MASK YET, BUT WHEN I WALK THE
DOGS, I ALSO WEAR A MASK.
SO I THINK IT'S REALLY IMPORTANT
TO REALIZE THAT THE MASKS ARE
IMPORTANT.
WE KNOW THAT THIS IS A DISEASE
THAT IS AIRBORNE AND AEROSOL
SENT OUT, AND WE ALSO KNOW THAT
THE N95 IS BETTER THAN THE
AVERAGE SURGICAL MASK, THOUGH I
THINK THAT ANY SORT OF MASK IS
BETTER THAN NONE.
WE ALSO HAVE TO RECOGNIZE THAT
WITH LOCKDOWN IN IN THE NURSIG
HOMES, A LOT OF NURSING HOMES
HAVE SLOWLY MOVED TOWARDS
TELEHEALTH AND I THINK
EFFICIENTLY WE WILL HAVE A HIGH
QUALITY OF TELEHEALTH, WHICH
WILL IMPROVE CARE IN THE NURSING
HOMES.
HOW WELL TELEHEALTH HAS DONE
OVER THE COVID PERIOD, WE DON'T
REALLY KNOW.
THE DIAGNOSIS OF COVID WHICH IN
NURSING HOMES IS DONE REGULARLY,
BECAUSE OF A REQUIREMENT, THE
PCR IS 97% ACCURATE.
IT DOESN'T DO A GOOD JOB IN THE
FIRST TWO DAYS, AND IT DETECTS
THOSE WHO ARE INFECTED.
ANTIBODIES, IGG STAYS UP LONGER
THAN IGM, AND DETECTS THOSE WHO
HAVE HAD DISEASE.
SO IF WE LOOK AT NURSING HOME --
THIS IS FROM THE SPANISH ARMY
WHO WENT -- WHERE THEY FOUND
MOST OF THE RESIDENT WERE DEAD
AND ABANDONED.
IT'S IMPORTANT TO RECOGNIZE THAT
MANY PERSONS IN NURSING HOMES
ARE POSITIVE WITHOUT SYMPTOMS,
SO REGULAR TREATMENT LOOKING FOR
SYMPTOMS IS IMPORTANT, TESTING,
AND THE EXISTENCE OF PERSONAL
PROTECTIVE EQUIPMENT IS VERY
IMPORTANT.
I STRONGLY FEEL THAT WE SHOULD
NOT TAKE UNTESTED HOSPITAL
PATIENTS, THE HOSPITAL SHOULD
TEST BEFORE THEY ARE SENT TO THE
NURSING HOME, AND WITHIN THE
NURSING HOME, IF PEOPLE ARE
SICK, YOU NEED TO HAVE ISOLATION
WHICH IS A PROBLEM SEEING OFTEN
PEOPLE SHARE A ROOM, AND THAT
REQUIRES HOW DO YOU TREAT THE
PERSON WHO IS NOT INFECTED WITH
A PERSON WHILE YOU MAKE SURE
THEY'RE NOT GOING TO GET
INFECTED.
OBVIOUSLY WHY NURSING HOMES DO
SO POORLY IS THESE ARE A VERY
VULNERABLE POPULATION AND LARGE
AMOUNTS OF INTERACTION AMONGST
THE POPULATION.
WHEN WE LOOK AT REHABILITATION
AND LONG COVID, POST COVID
CONDITIONS MAY ALSO BE KNOWN AS
LONG COI HAVE, LANGEVIN HAUL
COVID, POST-ACUTE COVID,
LONG-TERM EFFECTS OF COVID OR
CHRONIC COVID.
THEY'RE DIAGNOSED WHEN PRESENTS
HAVE BEEN PRESENT FOR THREE
MONTHS AFTER A COVID EVENT.
THEY'RE PRESENT IN 5 TO 45%, BUT
AS WE'VE SEEN FROM THE TALKS,
60% MAY STILL HAVE SOME SYMPTOMS
A YEAR AFTER THEIR COVID.
WHEN IT INVOLVES THE BRAIN, THIS
IS MYALGIC ENCEPHALOMYELITIS,
AND IF WE LOOK HERE AT PATIENTS
REPORTING COVID SYMPTOMS CAN BE
REALLY, BY 18 MONTHS, STILL 15%
OF PEOPLE HAVE THEM.
WHAT ARE THE SYMPTOMS?
WE'VE HEARD ABOUT SOME OF THEM.
OBVIOUSLY CONFUSION, EITHER AS
IT DELIRIUM OR DEMENTIA.
WORSENING DEMENTIA.
FATIGUE IS A BIG ONE, HEADACHE
IS A BIG ONE.
ALWAYS LOOK AT THE EYES.
THEY CAN BE RED, AN ANOREXIC,
DYSPNEA, WE'VE HEARD ABOUT
COUGH.
LOSS OF TASTE AND SMELL ARE
IMPORTANT AND DON'T GO AWAY
NECESSARILY.
CHEST PAIN OFTEN REMAINS, SOME
KIDNEY FAILURE, AUTONOMIC
NEUROPATHY INCLUDING POTTS IS PT
UNCOMMON IN MANY OF THESE
PATIENTS AND IS NOT WELL LOOKED
FOR.
PEOPLE HAVE JOINT PAINS AND
MYALGIA, SARCOPENIA AND CACHEXIA
DUE TO LOSS OF MUSCLE IS FAIRLY
COMMON, AND FALLS INCREASE.
THESE ARE PERSISTENT SYMPTOMS WE
HAVE TO LOOK FOR.
THE BEST EXAMPLE OF THIS THAT I
KNOW WAS A PICTURE PITCHER E
BOSTON RED SOX, EDUARDO
RODRIGUEZ, TO TOOK OVER A YEAR
TO RECOVER FROM HIS LONG COVID
SYMPTOMS AND HAD TO SIT OUT THE
SEASON FOR PLAYING FOR THE RED
SOX LAST YEAR.
CARDIOPULL MOTHERY EFFECTS, E
HAVE WHAT APPEARS TO BE
PULMONARY EMBOLI.
PULMONARY EMBOLISM IN LONG COVID
APPEARS TO BE PERIPHERAL, NOT
CENTRAL.
MYOCARDITE, EXTRAORDINARILY
COMMON.
MYOCARDIAL DISEASE CAN GO ON FOR
A YEAR OR SO AFTER LONG COVID,
MAYBE NOT RECOVER.
YOU NEED TO AVOID QTC PROLONGING
DRUGS AND ARRHYTHMIAS ARE NOT
UNUSUAL.
THE POST INFLAMMATORY LUNG
DAMAGE WHICH CAUSES DYSPNEA, WE
NEED TO DO LUNG FUNCTION TESTS,
IF PEOPLE ARE BREATHLESS, WE
NEED BREATHING EXERCISES AND
HOME PULSE OXIMETRY.
METHACHOLINE CHALLENGE IS
COMMON, AND PULL PULMONARY
REHABILITATION NEEDS TO BE DONE
AND HAS NOT BEEN DONE WELL AT
THIS MOMENT IN TIME AND MANY
PEOPLE WHO GOT LONG COVID.
THE SIX-MINUTE WALK TEST WAS NOT
DONE IN THE MAJORITY OF PATIENTS
BUT WHEN DONE, IT TENDS TO HAVE
POOR OUTCOMES EARLIER.
STIMULATION THERAPY CAN BE DONE
THE SAME WAY IT'S DONE FOR OTHER
CAUSES, AND YOU CAN GET ABOUT
TWO OUT OF THREE PEOPLE POST
INFECTIOUS, AND ONE OUT OF THREE
PEOPLE POST TRAWL MATIC WHO
IMPROVE.
THAT'S BASICALLY BEFORE COVID.
MOST PROBABLY THE SAME WITH
COVID.
FATIGUE IS AN IMPORTANT
COMPONENT OF COVID.
SARCOPENIA GOES ALONG WITH THE
FATIGUE, WEIGHT LOSS, TIS FOR D,
KEADY
DEPRESSION, PHYSICAL FRAILTY.
YOU CAN USE THE FRAIL TEST FOR
THAT.
THE TREATMENT INCLUDES GRADED
EXERCISE, LEUCINE ENRICHED AMINO
ACIDS, SUPPORTS AND
PSYCHOLOGICAL THERAPY, REFER TO
A PSYCHIATRIST IF THE PHQ9 IS
GREATER THAN 15, AND A NOCTURNAL
PULSE OX IF POSITIVE C PAP.
BRAIN FOG, WE'VE HEARD LOTS
ABOUT, AND WE HAVE TO RECOGNIZE
THE -- IT'S FREE, WORKS AS WELL
AS A MARKER, BOTH WORK BETTER
THAN THE DESH MENTAL -- M.
BRAIN STIMULATION GAMES,
COGNITIVE STIMULATION THERAPY,
EXERCISE, EX-CLUES DEPRESSION
AND SLEEP APNEA.
-- THESE HAVE BEEN SHOWN TO
DESTROY AND DAMAGE ENDOTHELIAL
CELLS WHICH CAN LEAD TO PROBLEMS
WITHIN THE BRAIN AS WELL AS
THROUGHOUT THE BODY.
THEY ALSO LEAD TO CACHEXIA AND
THEY LEAD TO A THICK ALVEOLIE
PRODUCING DYSPNEA.
THE EFFECT ON THE HEART INCLUDE
CHEST PAIN, DYSPNEA AND AUTO NO
MIBG
AUTONOMIC DYSFUNCTION.
POST VIRAL SYNDROME, WHICH I
FIRST SAW NEARLY 50 YEARS AGO AS
AN INTERN IN SOUTH AFRICA,
EPSTEIN-BARR VIRUS AT THAT TIME,
BUT ANY OF THE VIRAL DISEASES DO
THIS, AND IT'S IMPORTANT TO
RECOGNIZE THIS THERE ARE A
NUMBER OF THINGS YOU CAN MEASURE
LIKE THE D-DIMER AND THE ESR,
WHICH WERE ELEVATED AND HELP YOU
A LITTLE BIT, BUT WE HAVE TO
LISTEN -- RECOGNIZE THIS.
SOCIAL ISOLATION, OR THE
LONELINESS EPIDEMIC, IS
EXTRAORDINARILY COMMON IN OLDER
PEOPLE, AND IN OUR NURSING HOME
BEFORE THE EPIDEMIC, WE HAD 20%
OF PEOPLE IN NURSING HOMES THAT
HAD LONELINESS.
ACTIVITY WE PUSHED OP NURSING
HOME.
POST COVID THIS HAS GONE UP
QUITE A BIT.
AS HEMINGWAY SAID, NO ONE SHOULD
BE ALONE IN OLDER AGE BUT IT
APPEARS TO BE UNA UNAVOIDABLE.
WE RAN INTO THIS IN A BIG WAY IN
OUR NURSING HOMES.
SO TO CONCLUDE, I SHOULD POINT
OUT THAT A GREAT PAPER BY
SORENSEN, A CALL TO ACTION TO
UNDERSTAND, ENHANCE
UNDERSTANDING OF LONG COVID IN
LONG-TERM CARE HOME RESIDENTS.
WE MAKE THE CALL TO ACTION TO
THE RESEARCH COMMUNITY TO
RAPIDLY ADDRESS THE DEARTH OF
RESEARCH ON LONG COVID IN
RESIDENTS IN LONG-TERM CARE
HOMES.
CHALLENGES -- GUIDELINES FOR
LONG COVID MANAGEMENT AND ITS
UNIQUE CONTEXT, AND LONG HAUL
COVID STILL HAS A LONG WAY TO GO
FOR PATIENT AND CLINICIANS, AND
EVERY TIME I HEAR SOME
POLITICIAN OR DOCTOR TELLING US
THAT FUNDAMENTALLY COVID
PANDEMIC IS OVER, AND WE CANNOT
WEAR MASKS CAN NOT
WEAR MASKS IF WE DON'T WANT TO,
I REALIZE WE HAVE A LONG WAY TO
GO AND I THINK IT'S EXTREMELY
IMPORTANT AS A GERIATRICIAN THAT
WE CONTINUE TO POINT OUT HOW
IMPORTANT IT IS FOR PEOPLE TO DO
THE BASIC THINGS: VACCINATIONS
AND MASKS.
THANK YOU ALL VERY MUCH.
>> THANK YOU SO MUCH.
I WANT TO THANK ALL OF OUR
SPEAKERS, EVERYONE HAD A LOT OF
VERY HELPFUL INFORMATION TO
SHARE.
I WANT TO THANK OUR AUDIENCE.
WE GOT A LOT OF QUESTIONS.
WE'LL DO OUR BEST TO GET TO AS
MANY OF THEM AS WE CAN.
SO THE FIRST ONE I HAVE, I THINK
THIS IS PROBABLY FOR DR. BRISS.
HOW SOON AFTER YOUR LAST BOOSTER
SHOULD YOU GET THE NEW BOOSTER
FOR THE MORE RECENT VARIANTS?
>> ANY TIME THAT YOU'RE AT LEAST
TWO MONTHS OUT FROM YOUR
PREVIOUS -- ONCE YOU FINISH YOUR
PRIMARY SERIES, ANY TIME TWO
MONTHS AFTER YOUR LAST SHOT, YOU
CAN GET THE NEW BOOSTER, AND
THIS APPLIES TO -- THE BOOSTERS
ARE AVAILABLE FOR EVERYBODY AGES
12 AND OVER.
>> THANK YOU.
AND OUR NEXT QUESTION FOR
DR. MARQUINE, DOES BEING AWARE
OF THE NEGATIVE IMPACT OF THE
PANDEMIC POSITIVELY IMPROVE
OUTCOMES FOR HISPANIC, LATINO
AND NON-HISPANIC BLACK
INDIVIDUALS?
AND COULD THAT EXPLAIN THE
INCREASED POSITIVE IMPACTS ON
THESE TWO GROUPS?
>> SO VERY GOOD QUESTION.
I DON'T THINK WE HAVE A STRAIGHT
ANSWER TO THAT.
I THINK IT IMPORTANT TO KEEP IN
MIND THAT OF COURSE THIS IS ALSO
REPORT DATA SO THIS IS -- THIS
IS THE PERCEPTION OF PEOPLE,
WHAT'S HAPPENING TO THEM AND
WHAT HAS HAPPENED AND HOW THEIR
LIVES HAVE CHANGED.
SO I THINK -- I DON'T THINK OUR
DATA CAN DIRECTLY ANSWER THAT
QUESTION.
I DO THINK IT'S IMPORTANT, IT
IMPORTANT TO RECOGNIZE THAT,
AGAIN, PEOPLE'S PERCEPTIONS OF
THE EVENTS THAT ARE HAPPENING IN
THEIR LIVES.
WE'RE NOT GOING TO VIDEOTAPE
THEIR LIVES AND KNOWING, SO IT A
KEY THING TO CONSIDER AS WE
THINK ABOUT HOW THIS DATA MIGHT
INFORM FUTURE POTENTIALLY
INTERVENTION EFFORTS OR
PREVENTION EFFORTS FOR FURTHER
SYMPTOMS.
>> THANK YOU VERY MUCH.
I THINK DR. FRONTERA IS WORKING
ON HER VIDEO, SO I'M GOING TO
ASK A QUESTION FOR DR. NOBLE.
DOES THE RESEARCH TEAM BELIEVE
THAT THE SARS-COV-2 VIRUS
INCREASES DELIRIUM OR TRIGGERS A
SEPARATE PATHWAY IN INDIVIDUALS
WITH DEMENTIA THAT LEADS TO
DELIRIUM AS A SYMPTOM?
>> THAT'S A GREAT QUESTION.
I DON'T THINK WE FULLY
UNDERSTAND IT.
I THINK THE WAY THAT WE'VE TRIED
TO APPROACH IT IS THAT WE SEE
DELIRIUM AS A COMMON
MANIFESTATION IN INDIVIDUALS WHO
HAVE DEMENTIA, NO MATTER THE
CAUSE OF ILLNESS.
WE SEE THIS IN PEOPLE WHO HAVE
URINARY TRACT INFORECASTS,
PNEUMONIAS OR INFECTIONS,
PNEUMONIA OR FEVERS FOR OTHER
REASONS.
I'M NOT SURE COVID IS
NECESSARILY DISTINCT FROM THOSE
OTHER PATHWAYS.
IT MAY BE.
THE WAY WE'VE KIND OF
CONCEPTUALIZED IT, IT SEEMS AS
THOUGH COVID IS SOMEWHAT
DISTINCT IN THAT ITS
INFLAMMATORY STATE IS INTENSELY
ACTIVE IN ITS IMMEDIATE PHASE,
PERHAPS TO A GREATER EXTENT THAT
WE SEE IN THOSE MORE TRADITIONAL
INFECTIONS WE SEE IN DEMENTIA.
THAT PROVIDES US A MODEL OF
THINKING ABOUT IT FROM A
BIOLOGICAL PATHWAY.
IT'S ALSO MADE US WONDER, SINCE
IT IS SUCH A COMMON PROBLEM THAT
SO MANY PEOPLE HAVE FACED,
PROBABLY MORE COMMON THAN THINGS
LIKE URINARY TRACT INFECTIONS OR
PNEUMONIAS, THAT WE SEE MORE IN
THE LATER STAGES OF DISEASE,
COVID PRESENTS AN OPPORTUNITY
FOR US TO THINK ABOUT HOW
INFLAMMATION IN THE BODY IMPACTS
THE EXPRESSION OF DEMENTIA,
RECOGNIZING THAT OUR TRADITIONAL
MODELS HAVE BEEN A LOW GRADE
INFECTION OVER MANY YEARS OF
TIME OR LOW GRADE INFLATION OF
INFECTION WE SEE IN PEOPLE THAT
HAVE DIABETES, OBESITY, SMOKING
OR SEDENTARY LIFESTYLE, IS COVID
IN SOME RESPECTS SIMILAR TO
THAT, BUT IN AN INTENSE
HIGH DEGREE OF INFLAMMATION OVER
A BRIEF PERIOD OF TIME RELATIVE
TO THOSE OTHER TRADITIONAL RISK
FACTORS WHICH MAY HAVE A
LOW DEGREE OF INFLAMMATION, TO A
LOW DEGREE OVER MANY YEARS OF
TIME, PERHAPS EVEN PRECEDING THE
FIRST STAGES OF DEMENTIA.
FROM A CONCEPTUAL STANDPOINT,
THAT'S REALLY WHAT WE'VE BEEN
FOCUSED ON.
I HOPE THAT ANSWERS YOUR
QUESTION, AND I IMAGINE OTHERS
ON THE PANEL WILL HAVE SOME
REFLECTIONS ON THAT TOO.
>> THANK YOU.
WE'RE GOING TO MOVE ON TO THE
NEXT QUESTION FOR DR. FRONTERA.
WHAT INTERVENTIONS ARE BEING
TESTED FOR LONG COVID?
WHICH ARE MOST EFFECTIVE, AND
SIMILAR -- AND AGO THE SAME
LINES, WHAT CAN BE DOB DONE TO
PREVENT LONG COVID?
>> GOOD QUESTIONS.
MULTIPART.
I WILL SAY THAT THE NIH PUT OUT
A CALL FOR CLINICAL TRIALS LAST
MAY, AND THE CLINICAL TRIAL
CENTER SITE, COORDINATING SITE,
HAS BEEN NAMED, SO WE ARE
ANTICIPATING THAT CLINICAL
TRIALS WILL START UP SHORTLY,
AND I CAN ONLY SURMISE WHAT
MIGHT BE STUDIED BECAUSE I DON'T
THINK AWARDS HAVE BEEN ANNOUNCED
YET.
SO CURRENTLY THINGS WE'RE USING
THERAPEUTICALLY ARE REALLY
SYMPTOM-BASED, AND AT LEAST OUR
DATA, WHICH IS ONLY 122 PATIENTS
SO IT'S A SMALL COHORT, SUGGESTS
THAT THEY'RE STILL PRETTY
EFFECTIVE, EVEN WHAT CL
CLINICIANS ARE DOING BASED ON
SYMPTOMS AT THIS TIME.
CERTAINLY FOR POST COVID
HEADACHE, WE OFTEN EXTRAPOLATE
FOR WHAT WE DO FOR
POST-TRAUMATIC BRAIN INJURY
HEADACHE AND IT SEEMS TO BE
EFFECTIVE BASED ON SOME STUDIES
THAT ARE OUT THERE USING
AMITRIPTYLINE OR NORTRIPTYLINE,
WHICH MAY NOT BE OPTIONS FOR
OLDER PEOPLE, BUT CERTAINLY DO
SEEM TO HELP YOUNGER FOLKS WITH
POST COVID COGNITIVE ISSUES.
DR. MORLEY MENTIONED SOME
POTENTIAL COGNITIVE EXERCISES
THAT FOLKS MIGHT USE.
AGAIN, VERY LIMITED DATA IN THE
CONTEXT OF COVID FOR THIS.
I THINK THERE'S A LOT OF
INTEREST, IF I'M GOING TO
SPECULATE, I THINK THE FIRST
TRIAL MIGHT BE SOMETHING LOOKING
AT PAXLOVID IN TERMS OF THIS
CONCEPT OF LOOKING AT VIRAL
RESERVOIRS, AND ELIMINATING
VIRAL RESERVOIRS AS THEY MAY
CONTRIBUTE TO CHRONIC
INFLAMMATION AND POST COVID
SYMPTOMS.
BUT AGAIN, THAT'S JUST MY GUESS,
AND I DON'T KNOW WHICH STUDIES
ARE GOING TO BE STARTED SOON,
BUT THE GOOD NEWS IS THERE'S A
LOT OF MONEY PUT TOWARDS IT BY
NIH, AND I THINK WE'LL START TO
HAVE ANSWERS ROLLING IN, WHICH
PEOPLE ARE DESPERATELY WAITING
FOR.
>> THANK YOU SO MUCH.
JUST AS A FOLLOW-UP, I KNOW YOU
MENTIONED THE TREATMENT MIGHT
NOT BE GOOD FOR OLDER ADULTS.
COULD YOU ELABORATE JUST A BIT
ON THAT?
>> YEAH, I MEAN, SO THE TRY
TRI-CYCLIC DRUGS, REALLY AN OLD
GROUP OF DRUGS TYPICALLY USED
FOR DEPRESSION, ARE REALLY GREAT
FOR MIGRAINE-TYPE HEADACHES AND
POST-TRAUMATIC BRAIN INJURY
HEADACHES, AND THERE'S A
LITERATURE USING THEM FOR POST
COVID HEADACHES, BUT THEY CAN
HAVE THIS SIDE EFFECT OF
ACTUALLY INCREASING CONFUSION,
URINARY RETENTION, THEY CAN
CAUSE HEART EKG SIDE EFFECTS,
WHICH IS PARTICULARLY NOTABLE IN
OLDER FOLKS.
SO WE MAY NOT BE ABLE TO
NECESSARILY EXTRAPOLATE ALL THE
DATA WE HAVE IN POST COVID
POPULATIONS TO OLDER
POPULATIONS.
>> SO VERY IMPORTANT TO KNOW,
AND ALSO I'LL JUST PUT A PLUG IN
FOR THAT IS WHY IT'S VERY
IMPORTANT TO HAVE OLDER ADULTS
PARTICIPATE IN CLINICAL TRIALS.
OKAY.
MOVING ON TO THE NEXT
QUESTION --
>> CAN I JUST ADD ONE THING?
THE LITERATURE HAS SUGGESTED
THAT VACCINES DECREASE THE
AMOUNT OF LONG COVID.
IT'S NOT ABSOLUTE, BUT THERE IS
ENOUGH DATA THERE.
THERE HAS BEEN VERY LITTLE DATA
OR NONE THAT I KNOW OF LOOKING
AT PEOPLE WHO'VE HAD COVID, GET
LONG COVID, GETTING VACCINES,
BUT IT ACTUALLY MAKES A LOT OF
SENSE THAT YOU REALLY WANT TO
TRY AND GET RID OF THE COVID
THAT'S LEFT IN THE BODY CAUSING
LONG COVID, AND IT SEEMS TO ME
THAT THE THINGS THAT WE DO
REALLY BADLY AT THE MOMENT ARE
PAYING ATTENTION TO VACCINES AND
MAKING SURE THAT EVERYBODY GETS
VACCINATED.
SO SAME THING WITH FLU, IF YOU
DON'T GET IT FOR YEARS AND
PEOPLE DON'T GET FLU, OR THE FU
VACCINE DOESN'T WORK WELL, WE
HAVE TREMENDOUS PROBLEMS WITH
OLDER PEOPLE.
I THINK WE HAVE TO PAY MORE
ATTENTION TO THOSE, AND IT
TERRIFIES ME WHERE I HEAR LARGE
AMOUNT OF MONEY BEING GIVEN OUT
TO STUDY THINGS.
I RECOGNIZE THAT MEANS IT WILL
BE ALL UNIQUE, WONDERFUL
MARVELOUS THINGS WHICH I SPENT
MY LIFE STUDYING AS WELL, AND WE
WON'T PUT NEARLY ENOUGH MONEY
INTO THE SIMPLE THINGS.
JUST A THOUGHT FOR THE PEOPLE
OUT THERE WHO MIGHT BE DOING
THIS.
>> SO THE TAKE-HOME MESSAGE IS
VACCINES IN THIS CONTEXT ARE
ALMOST ALWAYS THE RIGHT ANSWER.
OVER.
>> THANK YOU, PETER.
I WISH CDC WOULD SAY IT A LITTLE
LOUDER.
>> OKAY.
NEXT QUESTION FOR DR. BRISS.
RELATED TO SOME OF THE TOPICS
THAT YOU COVERED.
THIS PERSON SAID, WITHOUT HAVING
A CRYSTAL BALL, WHAT TYPES OF
ADVERSE HEALTH OUTCOMES DO YOU
ANTICIPATE FOR OLDER ADULTS AS A
RESULT OF THE DECLINE IN
HEALTHCARE USAGE DURING THE
PANDEMIC?
>> THAT'S A GREAT QUESTION.
WE DON'T KNOW ABOUT OUTCOMES
YET, BUT WE DO KNOW THAT THERE
HAVE BEEN GAPS IN CARE, IN
HYPERTENSION MANAGEMENT AND
DIABETES MANAGEMENT, AND CANCER
SCREENING AND A LONG LIST OF
OTHER THINGS.
AND SO THE BOTTOM LINE IS THAT
WE HAVE A LOT OF CATCHING UP TO
DO AND IT'S TIME TO GET BUSY.
>> THANK YOU SO MUCH.
NEXT QUESTION FOR
DR. MARTINIQUE.
OF WHAT INTERVENTIONS HAVE BEEN
TAKEN TO ALLEVIATE THE EFFECT OF
THE PANDEMIC ACROSS OLDER ADULT
GROUPS AND PARTICULARLY AMONG
UNDERSERVED GROUPS?
>> SO I THINK IT DEPENDS ON THE
TYPE OF INTERVENTION THAT PEOPLE
ARE THINKING ABOUT.
SO I WOULD SAY SOME OF THE
BIGGEST ONES, I WOULD SAY
MENTIONED BEFORE MINIMIZE THE
NEGATIVE IMPACT OF THE PANDEMIC
IS HAVING VACCINES AVAILABLE, BY
HAVING THOSE ACCESSIBLE TO
PEOPLE.
LIKE IF WE ARE ABLE TO GET
VACCINATED, UNDERSTANDING THAT
MASKS ARE HELPFUL, THAT WE'RE
NOT THAT SURE WHEN ALL OF THIS
BEGAN, YOU MIGHT RECALL, RIGHT,
THIS WAS NOT PUT FORWARD IN THAT
WAY.
THOSE ARE THE TYPE OF
INTERVENTIONS AT A LOCAL LEVEL
THAT COULD HELPLESS PEOPLE GET
SICK, HELP LESS PEOPLE GET
SERIOUSLY SICK, AND BE ABLE TO
ENIMAIJ IN
ENGAGE IN A DIFFERENT WAY AND
LEAD OUR LIVES IN THE WAYS WE
WOULD LIKE TO.
SO THAT'S WHAT I WOULD SAY IS
KIND OF ONE BROAD SENSE OF
INTERVENTIONS.
I THINK THERE'S BEEN A HOST OF
DIFFERENT THINGS THAT PEOPLE
HAVE TRIED AT A SMALL LEVEL AS
WELL IN DIFFERENT GROUPS.
OF COURSE I'M NOT AWARE OF
ABSOLUTELY ALL OF THEM, BUT
THERE ARE PROGRAMS, FOR EXAMPLE,
I KNOW MY INSTITUTION AND TRYING
TO CONNECT OLDER ADULTS IN
DIFFERENT WAYS, HAVING PROGRAMS
TO DIGITALIZE THE POPULATION AND
THE OLDER ADULT POPULATION TO
HAVE THEM GET ACCESS TO NO THE
ONLY CONNECT SOCIALLY WITH OTHER
PEOPLE, BUT ACCESS TO CARE AND
SO FORTH.
SO THOSE ARE JUST SOME OF THE
FEW THAT COME TO MIND AT THIS
POINT, AND I KNOW SMALLER TYPES
OF INTERVENTIONS AS WELL.
BUT I'M SURE OTHERS ON THE PANEL
MIGHT HAVE SOME OTHER THINGS
THEY MIGHT WANT TO ADD AS WELL.
>> I DID NOTICE IN YOUR
PRESENTATION THAT ONE OF THE
POSITIVE IMPACTS THAT YOU
COMMENTED ON AND THAT YOU HEARD
FROM YOUR RESPONDENTS WAS THAT A
LOT OF THEM WERE DOING VOLUNTEER
WORK IN THEIR COMMUNITIES.
SO I KNOW THERE ARE EFFORTS FROM
PEOPLE WITHIN THE COMMUNITY TO
HELP WITH EDUCATION AND HELPING
TO EXPLAIN WHAT THE VACCINE DOES
AND WHAT IT DOESN'T DO HOW IT
CAN HELP TO TRY TO RAISE
AWARENESS OF THAT.
>> THAT'S A VERY GOOD POINT.
I THINK IN DIFFERENT COUNTRIES
AS WELL IN DIFFERENT WAYS, SO I
CAN SPEAK TO SOME OF THE OTHER
MEDIA I SEE IN LATIN AMERICAN
COUNTRIES FROM THESE
INTERVENTIONS AT A GLOBAL LEVEL
OF LIKE LET'S GET OUTSIDE IN
OPEN SPACES WITH NATURE.
ALL OF THESE THINGS, PEOPLE
DIDN'T USED TO DO AS MUCH AND
RECOGNIZING THE POSITIVE IMPACT
OF THAT.
AND THAT SENSE OF WE'RE ALL IN
THIS TOGETHER, WE'RE ALL LIVING
THROUGH THIS HISTORICAL TIME,
RIGHT?
WE'RE IN IT TOGETHER.
SO HOW CAN WE SUPPORT EACH OTHER
TO MOVE FORWARD?
I THINK JUST HAVING THAT MESSAGE
CUT ACROSS SEGMENT OF THE
POPULATION CAN BE VERY POWERFUL.
I'VE SEEN THAT HAPPEN IN OTHER
SPACES.
MAYBE NOT SO MUCH HERE, MAYBE IN
THE U.S., BUT MAYBE -- IN SOME
GROUPS, BUT THAT CAN BE VERY
POWERFUL AS WELL, THAT SENSE
OF --
>> I THINK WE ALSO NEED TO PUSH
THE OTHER PART OF PREVENTION,
WHICH IS MASKS.
YOU KNOW, THIS IS NOT OVER.
IF WE WANT TO KEEP ON GETTING
IT, IT'S GOING TO KEEP ON DOING
WHAT FLU DOES, WHICH IS CHANGE
ITSELF A LITTLE BIT.
WE'VE GOT TO BE MUCH MORE AWARE
THAT PEOPLE NEED THE MASKS AT
LEAST WHEN THEY'RE OUT IN
PUBLIC, INDOORS, AND IF PEOPLE
DON'T WANT TO DO THAT, IT'S NOT
GOING TO GET BETTER.
SO WE CAN BE LIKE SINGAPORE,
WHICH REALLY KNOWS HOW TO DO
THINGS LIKE THIS, SO LIKE THE
UNITED STATES OR BRAZIL.
BRAZIL IS ACTUALLY WORSE THAN
THE UNITED STATES.
I'VE BEEN THERE A NUMBER OF
TIMES, AND THEY HAVE LITTLE
INTEREST IN DOING ANY OF THIS AS
WE HAVE IN THE STATES, I THINK.
BUT WE REALLY DO NEED TO PUSH
THE POSSIBILITY THAT WE SHOULD
KEEP ON PREVENTING UNTIL THE
AMOUNT IN THE COMMUNITY IS VERY
LOW.
AT THE MOMENT, WE'RE NOWHERE
CLOSE TO HAVING A LOW ENOUGH
AMOUNT TO SAY THAT PREVENTION IS
NOT WORTHWHILE DOING, AT LEAST
IN MY, I THINK, SCIENTIFIC
OPINION BECAUSE THAT'S WHAT THE
SCIENCE SAYS AS WELL.
>> WE HAVE A QUESTION ASKED FOR
DR. FRONTERA BUT DR. NOBLE IF
YOU WOULD ALSO ANSWER.
CAN COVID CAUSE DEMENTIA
OUTRIGHT, OR IS IT MORE THE CASE
THAT IT CAUSES THE EXACERBATION
OF DEMENTIA?
>> SO YEAH, I WANT TO SAY WE
DEFINITELY DO NOT KNOW THE
ANSWER TO THAT YET, SO I WOULD,
YOU KNOW, NOT WANT PEOPLE TO
BECOME OVERLY ALARMED.
IT CERTAINLY AN AREA OF
RESEARCH, BUT I WOULD NOT SAY AT
THIS POINT THAT COVID OVERTLY
CAUSED DEMENTIA.
I THINK THAT CERTAINLY A LOT OF
US ARE LOOKING INTO IT, BUT I
WOULD HESITATE TO MAKE THAT
PROCLAMATION.
AND I'LL LET JAMIE ANSWER THE
PART ABOUT WORSENING DEMENTIA.
>> IN MY CLINICAL PRACTICE, I'VE
NOT ONLY SEEN PEOPLE GET WORSE
AFTER HAVING COVID BUT I'VE
ACTUALLY SEEN PEOPLE BOUNCE BACK
WITH NOT REALLY AN APPRECIABLE
CHANGE IN THEIR OVERALL
TRAJECTORY WHICH WAS HAPPENING
IN THE BACKGROUND.
IT FOR THIS REASON THAT WE
REALLY NEED TO WORK WITH THE
LARGEST COHORTS POSSIBLE TO
UNDERSTAND WHAT ARE THE
DIFFERENCES BETWEEN THOSE TWO
PEOPLE WHO SEEM TO HAVE THE SAME
DISEASE BUT HAVE VERY DIFFERENT
TRAJECTORIES?
TO THE POINT OF WHETHER OR NOT
IT CAN CAUSE IT, WE'VE ACTUALLY
UNDERTAKEN AT OUR CENTER A
NEUROPATHOLOGICAL STUDY OF
PEOPLE WHO INITIALLY PRESENTED
WITH COVID AND CAME TO PASS
BECAUSE OF THEIR ILLNESS.
AND FOR THE MOST PART, THE MAIN
CHANGES THAT ARE SEEN WITH UNDER
THE MICROSCOPE DO NOT SUGGEST
THAT THERE'S A STRONG VIRAL
INFECTION OF THE BRAIN CELLS,
BUT MAYBE NOR INFLAMMATION IN
THE SMALL VESTING STROKES THAT
WE'VE COME TO RECOGNIZE.
SO IN AND OF ITSELF, BRAIN
CHANGES ARE NOT THAT OBVIOUS
WITH THE EXCEPTION OF MAYBE SOME
MICROVASCULAR CHANGES.
WE'RE NOT SEEING AS THOUGH
SOMEBODY HAS A BLOSSOMING OF
ALZHEIMER'S CHANGES UNDER THE
MICROSCOPE, AND TO SOME EXTENT,
THAT REFLECTS WHAT WE KNOW OF
ALZHEIMER'S DISEASE IN THAT IT
TAKES YEARS FOR PEOPLE TO
DEVELOP CHANGES MICROSCOPICALLY
OF ALZHEIMER'S DISEASE THAT
EVENTUALLY LEAD TO THE CLINICAL
SYNDROME THAT WE SEE OF FOR
GETTING OR OTHER COGNITIVE
IMPAIRMENT.
SO IT'S A GREAT QUESTION.
WE DON'T HAVE A FULL ANSWER BUT
I AGREE WITH DR. FRONTERA.
>> ALONG THOSE SAME LINES,
SOMEBODY ELSE ASKED HOW DO THE
BRAIN BIOMARKERS TRANSLATE TO
DEATH?
DO YOU WANT TO MORE DIRECTLY
ADDRESS THAT?
>> IN OUR COHORT, PEOPLE WITH
HIGHER MARKERS,
NEURODEGENERATIVE MARKERS ALSO
HAD HIGHER RATES OF DEATH, BUT
THAT'S NOT ADJUSTING FOR ALL OF
THEIR FACTORS.
AND IT'S NOT SURPRISING THAT
PEOPLE WHO ARE SERIOUSLY ILL
HAVE LOW OXYGEN LEVELS, THEIR
BRAIN IS STAR OFFED STAFF,
THERE'S GOING TO BE SOME IMPACT
THERE.
IT'S NOT DIRECTLY CAUSAL,
MEANING THAT THAT BRAIN INJURY
LED TO THAT PERSON'S DEATH, BUT
IT IS A MARKER THAT THESE FOLKS
WERE REALLY SICK AND THAT
SOMETHING HAS INDEED HAPPENED TO
THEIR BRAIN, IT'S NOT JUST THAT
THEY HAVE LOW OXYGEN LEVELS AND
THEY'RE DYING IN HOSPITAL
BECAUSE OF LOW RESPIRATORY
PROBLEMS.
THERE'S NEUROLOGICAL IMPACT
ALSO.
>> WE RECENTLY PUBLISHED
BASICALLY A LIFE CHAIN IN PEOPLE
50 TO 65 WHEN THEY ELEVATED --
ASSOCIATED WITH EARLIER DEATHS
AND WE SAW TODAY COVID PUSHES
THOSE UP.
IT'S SAYING THAT IF THERE'S
DAMAGE TO PARTS OF THE TISSUE,
IT'S MORE LIKELY TO ACCELERATE
DEATH.
AND I THINK WE HAVE TO RECOGNIZE
THAT THAT IS MOST LIKELY THE
OUTCOME.
WE HAVEN'T LOOKED CAREFULLY TO
SEE WHAT'S HAPPENING TO DEATHS,
BUT IF WE LOOK, WE'VE DROPPED
THE AGE OF DEATH IN AMERICA
FAIRLY DRAMATICALLY OVER THE
LAST TWO YEARS, AND WE CAN SAY
THAT THAT OCCURRED NOT BECAUSE
OF COVID BUT BECAUSE OF
SOMETHING ELSE, BUT IT'S EITHER
ACUTE COVID BUT I THINK IT'S
MOST PROBABLY A COMBINATION.
AND I THINK WE NEED TO BE VERY
AWARE OF THAT AS WE GO FORWARD.
>> AND THERE'S ANOTHER RELATED
QUESTION, I'M NOT SURE WHO'S
BEST TO ANSWER THIS ONE, BUT
DOES COVID OR LONG COVID CAUSE
FASTER AGING IN GENERAL?
HAVE ANY STUDIES LOOKED AT
WHETHER IT INCREASES BIOLOGICAL
AGE?
ANYONE WANT TO TAKE THAT ONE?
>> THERE ARE NO DIRECT STUDIES
THAT I'M AWARE.
BUT AGAIN, THE INCREASE IN NFL
WHICH GOES ALONG WITH AGING
WOULD BE ONE OF THOSE.
INCREASED CYTOKINES TEND TO
INCREASE THE RATE OF AGING, AT
LEAST IN ANIMALS, WE'VE DONE A
LOT OF STUDIES WITH ALZHEIMER'S
MODEL -- ALZHEIMER'S SHOWING
THAT'S THE CASE.
SO I THINK WE SHOULD ASSUME THAT
IT'S TRUE IN OUR NURSING HOME
STAFF, WE'RE FINDING A LARGE
NUMBER OF STAFF WHO CAN'T COME
BACK TO WORK A YEAR LATER, THEY
STILL FATIGUE AND THEY FINISH UP
RETIRING.
SO FUNDAMENTALLY, I THINK THAT
THE MOST -- THOSE ARE STUDIES
THAT NEED TO BE DONE AND HE?
ARE LONG AND THEY
ARE LONG TERM STUDIES.
YOU'RE NOT GOING TO GET THE
ANSWER IN SIX MONTHS.
IT'S GOING TO TAKE YEARS TO
UNDERSTAND WHETHER WE'RE
ACCELERATING AGING, WHETHER OR
NOT PEOPLE WHO'VE HAD COVID ARE
GOING TO DIE TWO, FOUR YEARS
LATER EVEN IF THEY DON'T HAVE
LONG COVID, WHAT THE TWO LONG
OUTCOMES ARE GOING TO BE.
I THINK WE NEED TO PAY A LOT OF
ATTENTION TO THAT.
THAT'S MY OPINION.
AGAIN, WE DON'T HAVE ANY SCIENCE
TO BACK IT AT THE MOMENT.
>> OKAY, THANK YOU ALL VERY
MUCH.
IT SHOWS ON MY CLOCK AS NOON
EASTERN, AND THAT IS OUR END
TIME, SO I WANT TO THANK
EVERYONE, THE SPEAKERS, THE
ATTENDEES AND THE FUTURE
WATCHERS OF OUR WEBINAR.
I HOPE THAT YOU ALL STAY TUNED
FOR UPDATES ABOUT OUR UPCOMING
FOCUS ON AGING FEDERAL PARTNERS'
WEBINARS, AND THERE'S THE LINK
ON THE SCREEN TO BE ABLE TO KEEP
UP, AND AGAIN, THANK YOU ALL
VERY, VERY MUCH.
TAKE CARE.