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www.planetree-sv.org 
March 2020
Director’s message

As vaccines roll out throughout the U.S. (including a third vaccine, a one-dose version from Johnson & Johnson, that topic dominates the news. This e-newsletter is no exception, although we’ve tried to add a bit of sweet variety for you. In this issue of PlaneTalk we cover the most pressing issues around COVID vaccinations for people in Santa Clara County right now; but/and there’s a wealth of more information on the Vaccines webpage of PlaneTree Health Library’s online Coronavirus and COVID-19 Resource Guide. It’s updated frequently - at least weekly and sometimes daily - to help us all stay on top of how we can protect ourselves, our loved ones, and the people in our communities.

In a past survey of our readers, many of you wrote that you really appreciated our list of health-related free events. When the pandemic hit, the organizations that put on those events scrambled to find ways to continue to offer their programs - and many events have moved online. So many, in fact, that this e-newsletter can’t list them all. So PlaneTree Health Library is now hosting a health events calendar on our website for free online programs on health-related topics of interest to older adults and their care partners. While our staff moderate the listings to keep out spam and advertisements, organizations are invited to submit their programs directly. Please help us spread the word about this calendar, to make it even more awesome - and do take advantage of these stellar programs.

SHOULD I...?

Wait to be contacted by my health insurance to get a vaccination appointment, if I’m eligible?

While vaccine rollout has significantly improved in the last month, there is still confusion and delays as organizations create processes for this unprecedented effort. It may be that information from your health insurance or your doctor’s office may not be completely up-to-date (or they may not be among the first to know). 

If you are eligible, and if you are anxious to get vaccinated, check out the alerts and waitlists for your county, as linked from our online guide

California has a statewide registry, but individual counties can also set up their own systems (as Santa Clara and Alameda Counties have done) which can further complicate the process; we recommend checking both state and local scheduling websites to increase the chances of getting an appointment. (Alameda County; Santa Clara County). It’s worth noting that Santa Clara County has a “no wrong door” policy, which means that all vaccine providers listed on the link above (with the exception of the VA) “are able to vaccinate eligible patients regardless of your healthcare provider or insurance.” 

Another option is to get vaccinated at a pharmacy. The large retail chains (CVS, Walgreen’s, Rite Aid) are offering this; if that’s a convenient route for you, the commercial service GoodRx offers email notifications for when doses are available. Sometimes pharmacies will offer last-minute vaccinations when they have doses left over from appointment no-shows.

No computer or internet?  If you have family or friends who don’t have easy access to the internet to schedule an appointment, there are phone numbers to call. For Santa Clara County, eligible residents can also make appointments for the County Health System vaccine sites through the Valley Connection Call Center at 408-970-2000. That Call Center is open Monday through Friday from 7am to 9pm and Saturday and Sunday from 8am to 4:30pm.  Assistance is available in English, Spanish, Vietnamese, and multiple other languages.

Only look for a vaccination appointment near my home?

Yes and no. If the vaccine is coming from a county agency, that location will serve only people who live or work in that county. But if you’re covered by a large healthcare system like Kaiser Permanente and you’re getting it from them, the next available appointments at one of their locations might be a distance away. Of course, transportation can be an issue. To help with that in Santa Clara County, VTA public transit serves all the regular vaccination locations, and transportation is free at this time - see this route map for details.

Should I only schedule a vaccine appointment when my preferred brand is available?

The news is full of stories that compare the Pfizer/BioNTech, Moderna, and now Johnson & Johnson's vaccines. Unless you have been specifically advised to do this by your healthcare team, don’t try to choose which version of the vaccine you will get when making your first appointment. That’s counterproductive, says Dr. Anthony Fauci. What matters most - for you and for the rest of us, too - is to get vaccinated as soon as you're eligible. (Many vaccine locations won’t know which brand they will have at a given time, anyway.)

Be sure to get my second vaccine dose with the same brand of COVID vaccine?

Once you do get a first dose of either the Pfizer/BioNTech or  Moderna vaccine, though, the current medical recommendation is to get a second dose of the same brand. We don’t know whether it would make a difference, but it could - and the goal is to maximize your immunity. By the way, this issue doesn’t come up with the Johnson & Johnson vaccine that was recently approved since that uses only one dose.

Wait, but you just wrote that we shouldn’t try to schedule an appointment to get a specific brand of vaccine! This isn’t exactly a contradiction;  supposedly, the scheduling systems in place will match you with the same brand for your second dose. There might be some last-minute shortages, though, so that second dose might be rescheduled if it runs out. The good news is that the time between doses has some leeway.

Eat dark chocolate for my health?

Various chemicals in cacao beans may have some health benefits, and dark chocolate has a higher percentage of cocoa to fat than milk chocolate or white chocolate. So it’s a healthier choice - but it still may have high amounts of sugar. Best to consider it a treat, not a health supplement.

Take melatonin to prevent COVID-19?

Some recent news stories suggest that melatonin can prevent SARS-CoV-2 infections, and/or prevent a bad case of COVID-19. But It's too soon to tell whether it has any positive effect.

Melatonin has proven to be useful to help reset our "biological clock", our circadian rhythms, when travel or shift work puts our bodies out of sync with the local time zone. It can help with sleep onset insomnia (although it's not the first choice treatment for problems with falling asleep); it doesn't do much for sleep maintenance problems (staying asleep). 

There isn't a consensus (yet) about other claims for this substance, however. Read more from the National Center for Complementary and Integrative Health if you're considering taking melatonin.

And be aware that there isn't much surveillance or quality control on products that claim to contain melatonin. Best bets are products that have been certified by the US Pharmacopeia or another third-party testing lab (and search the lab's name too see if you can tell if it is a valid concern).

Take a mini-vacation from screen time to protect my eyes?

Many of us spend far more time staring at a computer screen in the last year than we did before, and could benefit from some vision self-care. While using a computer won’t ruin your eyes, it can cause eye strain and fatigue. Proper positioning; paying attention to screen brightness, contrast, and glare; staying hydrated all help. Ditto taking a moment to rest your eyes (blink, focus on something 20 feet away for a moment) and to stretch neck and shoulder muscles.

IN DEPTH:
CA Access to COVID vaccines for medically-vulnerable
people and their caregivers.

The state announced recently that medically-vulnerable people will be eligible to get the COVID vaccine as of March 15, 2021. It is up to healthcare providers to determine whether someone’s pre-existing conditions put them in the very highest risk groups for COVID-19, although the California Department of Public Health has listed the following conditions as examples of qualifying health issues:

  • Currently being treated for cancer (with weakened immune system);
  • Chronic kidney disease (stage 4 or above);
  • oxygen-dependent chronic pulmonary disease;
  • Down syndrome;
  • a weakened immune system due to a solid organ transplant;
  • Pregnancy;
  • Sickle cell disease;
  • Heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies (but not hypertension by itself);
  • Severe obesity (Body Mass Index ≥ 40 kg/m2);
  • Type 2 diabetes mellitus with hemoglobin A1c level greater than 7.5%.

While people with Alzheimers or other dementias can also be at-risk, those diagnoses don’t automatically qualify for vaccination at this time, although a physician could consider it a “developmental or other severe high-risk disability [when] one or more of the following applies:

  • The individual is likely to develop severe life-threatening illness or death from COVID-19 infection
  • Acquiring COVID-19 will limit the individual's ability to receive ongoing care or services vital to their well-being and survival
  • Providing adequate and timely COVID care will be particularly challenging as a result of the individual's disability”

 The Provider Bulletin gives more details. (Also, people 65 or older are already eligible by age, and do not have to give any other qualifying reason.)

While it’s relatively easy to show proof of age or employment to qualify for the vaccine, it’s much more complicated to show proof for a medical condition. People who fit into those categories would be wise to check into how they can prove their eligibility. There is no consensus yet on how to do this. An advisory task force is working to identify what documentation will be accepted, but those guidelines have not yet been released yet - once they are published, PlaneTree Health Library will link that information to our COVID Vaccines online guide.

Main caregivers (either paid carers or informal, family caregivers) for older adults and medically-vulnerable people are already eligible as of this writing, under the February 13 guidelines from CDPH. Those requirements state that  family caregivers “must obtain documentation from their regional centers, verifying the qualifying condition of the family member cared for and caregiver status.” (Only the designated caregiver is eligible for now, not other family members. ”This does not include other family members within the same household who do not provide direct care to the regional center consumer.”) And as this story illustrates, even with proper documentation, people could be turned away out of ignorance of guideline details or fear of a scam. For now, advice for family caregivers is to collect more documentation than just the regional center verification, and to keep trying.
IN DEPTH:
Participation in Clinical Trials

Those who have been following the discussions about which vaccines are authorized to be used in the U.S. know that decision is made by the U.S. Food and Drug Administration, and based on how well the drug performed in clinical trials. As the National Institutes of Health put it, “Clinical trials are at the heart of all medical advances. And volunteer participants are essential to clinical trials.” People with medical conditions who are looking to find better treatment are recruited for clinical trials, but they often also need healthy people, too. Participation is always voluntary, and depends on informed consent; participants can drop out any time.

It is also crucial that participants in clinical trials accurately represent the people they’re intended to help, with similar ages, genders, racial and ethnic backgrounds. (So far clinical trials for COVID vaccines have only recruited adults, which is why those vaccines have not yet been approved for children under 16.) Unfortunately, too many clinical trials skew towards adult white men, which ends up with gaps in knowledge. Treatment guidelines that don’t know if a drug doesn’t work as well on women, or has more serious side effects on older adults, or medical devices with built-in bias (like pulse oximeters,  that are not as accurate on darker skin or with polished fingernails) can endanger lives - and could be avoided if their clinical trials had more diverse participants.

To learn more about how clinical trials recruit participants and on various efforts to make medical research more inclusive and diverse, these links are good places to start:

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