The Square
News and perspectives from Covia.

Dr. Timothy Gieseke, who served as the Medical Director at Spring Lake Village from its opening in 1986 until 2019, sat down on Monday, December 14 for an interview with Laura Darling, Covia’s VP of Communications and Spiritual Care, to give his perspective on the safety and effectiveness of the COVID-19 vaccines. Gieseke is a member and past President and Board Member of the California Association of Long Term Care Medicine (CALTCM). The full interview is available online here.

Dr. Gieseke gave an overview on how these novel vaccines were developed and how they work. Using a well-established technique that has been in use for the past 10 years for cancer therapies, scientists created a messenger RNA, or mRNA vaccine for SARS CoV2. Not using the COVID virus itself, the mRNA vaccine “creates a sideshow, if you will…so the body sees it as a foreign protein and makes antibodies against it. So that when the virus actually does infect us, or attempt to affect us, very quickly it’s identified as something foreign to be destroyed and the virus is destroyed.”

Like every other therapy approved by the FDA, Dr. Gieseke explained that the COVID vaccines went through three trial phases. “Physicians get interested in the phase three study, which is where they had 43,000 volunteers” – 30% of whom were from ethnically diverse backgrounds, and 45% between the ages of 45 to 85.

After a phase 3 trial lasting two weeks longer than the usual period and review by committees, including the Vaccine Related Biologicals Products Advisory Committee (or VRB PAC), “at a federal level, they felt that this vaccine was effective at a 95% level, which is really amazing.”

It’s effective. But is it safe? Dr. Gieseke explained that although “this was a rapid review, rapid approval process, but the actual scientific process was the same.”

“There’s things that we don’t know about this, but that’s true of everything in medicine, that’s new,” he says, “But the potential value of this vaccine is so large that I can tell you I’m signing up, all my associates at Spring Lake, Drs. Greene and Rao are signing up. I had another colleague say, ‘Where can I get it?’ And I can tell you, physicians are just really excited that this vaccine is available.”

A review of the side effects did not raise any alarms for him. “I mean, there are always problems with these medications and there’s problems even after you get your emergency use, but the common ones were the ones you’d expect,” he said. Side effects were similar to those of the flu vaccine: soreness at the injection site, or a systemic immune response, “feeling like you’re getting the flu, because that’s part of your immune system, how it gets rid of the flu and actually SARS CoV2 as well.” Dr. Gieseke said these side effects were found in less than 3% of trial participants after receiving the first injection, and less than 7% of people after receiving the second.

The vaccines are given in two doses because “you get more effectiveness and better safety if you split the doses,” Dr. Gieseke explained. “So rather than giving a big dose all at once, you give a tolerable dose and then you repeat it three weeks later.”

“I think it’s effective and safe and it’s something that when your turn comes I would be, ‘I’m gonna be the first in line,’ quite frankly,” Dr. Gieseke says.

The Pfizer vaccine has already been approved, and the Moderna vaccine is not far behind. Dr. Gieseke thinks the Moderna vaccine may be the one more likely to be given to Covia residents and staff. “The Moderna vaccine which is an mRNA vaccine has very similar 94.7% effectiveness, differs in that it does not require the cold storage that the Pfizer vaccine does. So it’s more like a normal vaccine, has a better shelf life.”

So when will we all be vaccinated? “Hard to know,” Dr. Gieseke says. “Experts are predicting anything from May, June, to more likely the Fall, September, something like that, because these companies are selling to the world. It’s not just the United States.”

In the meantime, Dr. Gieseke says we need to continue to follow public health guidelines – including wearing masks, avoiding gatherings and enclosed spaces, and cleaning. “What we know about SARS CoV2 is public health actually works. But you really have to practice it effectively and I’ll just give you a couple principles that you may not want to hear:

“Now that medical masks are available, that’s what you should be wearing. And the reason medical masks are more effective than the cloth masks is, they actually have electrostatic forces that trap the virus embedded within them,” he says. Dr. Gieseke reuses his masks, storing them in a paper bag to allow them to dry out and be used again.

“Number two: Always use a mask when you’re outside your apartment because you just don’t know… all it takes is one person to not mask to blow the whole thing open, and I see that happen all the time.”

Number three: “follow public health guidance. So right now we’re on lockdown. Because in December, every week we’re doubling and tripling the prevalence of COVID. And what we know is the more common the COVID is in the community, the more likely we are to get COVID.”

Dr. Gieseke says that, even with the vaccine, “continue to do all the public health measures until public health says this no longer makes sense.”

Dr. Gieseke does have words of encouragement for everyone who has been dealing with the limitations imposed by COVID over the past year: “Number one, this is not forever.”

“I think the vaccines is going to allow us to have a more normal life, even if the virus has the ability to change like influenza and becomes a persistent problem,” he says. “I don’t think we’re going to see it out of control, like it is right now…Going forward, I think this will be a part of our lives. But I think it’s going to be a manageable part of our lives.”

Although the vaccine is good news, for right now his guidance is, “mask as much as you can. That’s kind of where you live at this point in time.” But, Dr. Gieseke assures us, “this too will pass.”

When Pat Lau, Activities Coordinator for Webster House in Palo Alto, first created the Healthy Connections program in 2016, she had no idea the kind of impact it would eventually have.

“I thought, ‘Oh, I’ll just have a little volunteer program. They can work with the residents, meet them, talk to them,’” she says. “But it evolved into so much more.”

Now in its third year, Healthy Connections partners with Stanford University’s Office of Undergraduate Advising to provide pre-med students with a setting to gain clinical experience as well as giving residents in the Health Center the personal connections that studies continue to show are beneficial to people’s health and well-being.

Webster House and its affiliated Health Center are located just a mile away from Stanford University. With physicians from Stanford and the Palo Alto Medical Foundation making rounds at the Health Center daily, the program offers valuable experience for students interested in exploring the medical field.

In addition, the program exposes pre-med students to the need for, and importance of, geriatrics as a medical specialty. According to the American Geriatric Society, 20,000 geriatricians are required to keep up with the need right now, and that need will only grow as the population ages. There are currently fewer than 7,300 certified geriatricians practicing nationwide.

Volunteers for the Healthy Connection program must spend a minimum of three hours each week with the residents and at least 100 clinical hours at the Health Center. “Most of the students, though, work well beyond the hundred hours and some have gone on to two hundred hours,” according to Lau.

Students must be 18 years old, pass a criminal background check, be screened for tuberculosis, and attend an in-depth orientation. “There’s a number of regulations and things they need to know about if they’re going to be in a health care setting and working with a vulnerable population such as older adults,” Lau explains, including the Health Information Portability and Accountability Act (HIPAA), patient rights, elder abuse, infection control, and safety procedures.

So far, 12 students have participated in the program. Four of the 12 students who have been through the program have been accepted to medical school.

“Everyone seemed to benefit,” Lau says. “The student was exposed to a clinical environment, but most of all, there was a very strong, caring, and reliable relationship.”

Healthy Connections recently received a Sereno Group 1% For Good grant from the Palo Alto office. 1% for Good provides grants to local organizations that are active in improving our communities. Sereno Group Palo Alto will be supporting Healthy Connections from July through September 2018.

Brian Chancellor from the Sereno Group says, ““We were intrigued and touched by the inter-generational experience between the students and the residents. It’s exciting to support them all in their care and cultivation of such a relationship when it is so greatly needed and appreciated.”

As the new school year begins at Stanford, students can anticipate another benefit of participating in the Healthy Connections program: Dr. Peter Pompei, a professor at the Stanford Medical School, general internist and geriatrician with 20 years of clinical experience, will serve as the program’s medical director, providing mentorship and support for the students.

But it’s the relationships built between the residents and students that most impresses Lau. “These students really help support these older adults. They improve the quality of their lives. And for me, I can’t tell you what I feel when I see some of these individuals smile.”

For more information on the Healthy Connections program, please contact Pat Lau at plau@covia.org.

May 30, 2018 marked the 25th anniversary of National Senior Health and Fitness Day, which is observed annually on the last Wednesday in May. We interviewed Esteban Sahade, Wellness Coordinator for St. Paul’s Towers, for his insights on senior health and fitness. 

How did you get involved in senior health and fitness?

When I was in grad school I took an internship to work in health and fitness with seniors. It was an opportunity to learn something I was little familiar with. As I started I discovered a new, fascinating world. I felt that all my previous training, experience and even my personality came together and preparing me for that. Soon afterwards I knew it was what I wanted to do from that moment on.  

What (if anything) is different about senior health and fitness from being a fitness trainer for other populations?

From a fitness perspective I think it’s a most rewarding experience. You can positively impact so many lives. With a relatively small investment of time and energy you can see fast and profound functional changes. You’re directly helping them improving their quality of life, independence, and dignity.  Besides that, older adults recognize and are grateful for any effort, little or big, in helping them improve, and the time you put into it.

What do you think would surprise people about senior fitness?

One thing that surprises many people is to know that the rate of improvement in some fitness components, like muscular strength, is similar for people in their 90s and people in their 20s. There are challenges, but with good care, the right stimulus, and in the absence of disease and injuries/accidents, the aging human body is capable of outstanding physical achievements, as shown by the performance of senior athletes who train and compete in many sports and age categories, including 100+.

What do you recommend for someone who wants to stay fit and healthy as a senior?

Find activities you like and enjoy. Exercise is not really necessary if you have a diverse physically active lifestyle. The movement involved in regular activities such as grocery shopping, gardening, domestic chores, visiting friends or family, playing with your grandchildren, walking your dog, dancing, travelling, etc., may be all the stimulus your body needs to stay fit and healthy. Add movement throughout your day; for example, stand more times, walk more when you have the opportunity (or create some), and use the stairs if you can.

Why is it important to recognize senior health and fitness?

Because it’s not about exercise, it’s about life and dignity. Failing to recognize its importance creates a negative social conditioning. Even if times have changed, many people, including family members, still think that their elders are too old or too frail to move or to exercise. This results in lost opportunities and motivation for seniors to get more fit and be healthier, creating an environment that leads them to an accelerated decline and functional loss.

What have you learned from working with seniors on health and fitness?

It doesn’t matter how active (or little active) you’ve been all your life. It’s never too late to start moving more, or different, and increase your body functional capacity which will result in positive changes in your life, improved wellbeing (not only physical, but also psychological, emotional, and even social), and better quality of life.