 So everyone, good morning, good afternoon, good evening saan manpaling po kayo ng daigdig na ruon kayo, welcome to the 92nd episode of the Stop COVID-19 Webinar Series brought to you by the University of the Philippines. Maraming salamat po for being a part of our credible online community and to all those who have just discovered us for the very first time today, welcome po at sana po marami po kayong matutunan sa webinar po natin today. The COVID-19 pandemic and the subsequent lockdowns have brought a lot of suffering as people had to stay indoors, isolate when exposed, and refrain from social activities. Marami po talagang na-apektuhan pero none more in terms of the difficulties than our senior citizens. Mula po sa simula, the seniors were at highest risk for infection, hospitalization, and even death so they're really a vulnerable group and as a society that cares deeply for our aging and elderly population, extraordinary precautions have been taken to prevent our seniors from exposure to the virus. The risk of exposure has been a serious concern of our frontline healthcare workers who found it unbearable to think that they could bring or cause an infection sa parents po nila, or grandparents sa two wing uwi po sila galing po sa hospital. So it has been a long time since we have allowed our seniors to go out and interact with others and for many, it has been a lonely journey para po may mga silent sufferers kong baga po and the stress of being isolated and feeling helpless during that point in time. So ngayon po na tayo po ay nandito na po sa alert level one na tinatawag ang ating pun topic for today. Pwede na po ba or is it safe for our senior citizens to go out? So if you want the latest science-based and evidence-based information from a panel of distinguished experts, please keep it right here. I'm Dr. Raymond Frances Cermiento, Director of the National Telehealth Center, National Institute of Health, University of Philippines, Manila. Always a pleasure to be with all of you. We are seeing a little over 600 participants po sa ating Zoom webinar. Hopefully mas madag-dagan po ito and as always I get to share hosting duties po and it's my pleasure and honor to introduce our adjunct faculty at the National Telehealth Center, also the Special Envoy of the President for Global Health Initiatives, Dr. Suzy Pineda Mercado. Hi Raymond, good afternoon. Magandangapon po sa yung lahat. Really nice to see everyone's names coming up on the chat. So from all over the Philippines again Raymond and Nako, did you say 92nd episode? 92nd episodes na tayo. So welcome po sa yung lahat. We hope you're going to enjoy and learn a lot from the discussion today. Alam nyo yung mga senior natin eh, dati-datiton ko ah sila kasi kakain sila sa labas may 20% discount. Tapos big lang dalawang taon, di sila makapuntas sa mga restaurant. Yung sine libre, pula na masin yung mapupuntahan. So tanong natin, safe nang aba talaga, tsong ano dapat yung mga alalahanin natin bilang mga anak o mga apo. How can we keep our seniors safe? So I think you're going to like our episode today. As always we have the best speakers for you and we'd like to thank our speakers in advance for giving us this time and this opportunity. So pag-usapan po natin yan kung safe nang ating mga seniors. Sige Raymond over to you. Thank you Dr. Suzy and for those who are joining us for the very first time for this webinar, meron po tayo laging hinahanda na tinataw po natin person on the street interview video. It's developed by the team over TV UP. So ang katanungan po that we pose to our interviewees sa tingin po ba ninyo? Safe na lumabas ang mga senior citizens at bakit? Please watch this. Ang senior, siguro sa palagay ko, hindi mga nakapabaksin, hindi siguro safety. Pero sa ngayon siguro ang naka senior citizen, nakabaksin na siguro, hindi na siguro mga umobas. Pero hindi masado. So tingin ko naman safe na siya. Bukod sa siyempre, di ba? Wala nagaanong surge. Tingin ko rin maganda na hikayate nating sila o pahintunutan natin silang lumabas kasi yung mga nakakasalamuhan naman nila sa ba'y ay lumalabas hindi. Yung mga senior na, ibang senior na hindi pabaksin, siguro mas limit limitahan pa natin. Pero yung mga vaccinated na talaga, pwede nang lumabasa ngayon. Paguro ko sa umobas ng mga elderly nowadays, kasi kailangan din nila ng exercise. If they're vaccinated and they're unalang pwede, I encourage to be vaccinated naman ko. Ayun naman ko. I think they're safe. Pero if they have this, mayroon ko silang province with their lungs, yung respiratory problems ko, ayun ko. They need to consult sa doctor and they need to be more careful kung sang sila po punta, lala na naku-crowded places ko yung mga upundahan ko nila. On the psychological and social side, maganda, it's a good idea na makalabas na sila. Since yung mga seniors na 50 nalad, they need to be included sa community. Sa tadig ko, kasama ko po yung lola ko. She's nine years old nako and very strong nalaka. So, ano ko siya nagpabaksin ko siya last year, I think mga June-July ko mga mid-year last year. Ayun yung po lobas. I'm newly wed nung February. So ayun. Eh, di ba, last year, so bram lala nung COVID talaga, talaga, pwede mag-event yun. The next time, hindi pwede. So talagang, totaly, ayaw talaga yung spunta sa wedding ko. So nung nakita namin, nabubaba ng bubaba yung cases, na gilalaks na ngayong mga LG News. Ayun, napapantapong siya on-site ngayong mga wedding ko, which is out there naman ko. Sigurod, this time, ipagkaloobnat natin sa kanila yung ganoon. Nakalaya ang lumabas, kalaya ang sumaya sa labas ng kanilang mga tahanan. So para, di ba, further sanity rin. Sa mga senior na hindi pa nagbabakuna, para sa safety natin, siguro pwede na kayong lumabas at magbabaksin para kagaya namin. Pwede na kaming lumabas, mag-enjoy, nailangan natin magbabakuna para sa safety ng lahat. Hindi lang sa atin nakabakuna na, pero para na rin sa inyo at sa mga anak natin. Thank you very much TV UP. Ano, wala ako yun. Thank you so much TV UP for that. It's always nice to hear from ordinary people. And thank you for all of those who agreed to be interviewed. Apasalamatin kami. Maraming laging okay sa kanilang mag-interview. So maraming salamat kusay nyo. And of course we use these interviews to reflect on ano bang iniisip ng pangkaraniwan tao. At kayo po, bilang mga frontliners, di parang mga pasyentin nyo yan, di ba? Iyan ang mga iniisip nila. So tutungoan po natin yan, tutuntunin natin kung ano nga ba talaga ang dapat gawin parallelin sa mga seniors natin. Mga ming magagantang idea, sabi ko hantay, hindi ako dapat hindi sa crowded na lugar. At tama ay mga gana nanot siya ako meron silang sakit. So mamaya pagusapan pa natin yan, pero ngayon meron mo lang tayo announcement. We've got an announcement. In relation to our second year anniversary, Raymond, ano ba yan, two years na tayong magkakasama, alam nyo ba hindi pa kami nakikita-kita yung team, we have not seen each other yet in person but anyway, we have a second year anniversary on April 9 and of course we would like to dedicate that particular episode to our COVID-19 heroes and we have a COVID-19 heroes memorial. We're still making a call for photographs for the name, date of birth, date of death, occupation of your loved ones or friends. Pa'y hindi ako kundi pa lang ang magdibigay. So ano, isama natin kumeron po kayong mga larawan dyan, you have pictures that you'd like to share. Because we just want to remember, we don't want to forget the sacrifice that our frontliners have made. Some of them have given the ultimate sacrifice na. So ito po ay, before April 9, padala nyo po sa amin at kelangan po 300 dpi dots per inch. May natutunan na kong bagod dots per inchin po ang resolution, dapat ay resolution po ang larawan natin. So yung po kalimutan, kaya kumiyan po kayong mga kaibigan, palalan nyo lang na, this is our little way of putting this together. I think it's looking better now na sa alert level one na, sana makahingan na tayo, pero wag natin kakalimutan ang sacrificial ng ating mga kapa-frontliners. Okay, over to you Raymond. Yes, thank you so much, Dr. Susie. So ang Filipino medical frontliner po, napita nyo na rin po sa mga balita, how they have been recognized as one of the best po in the world. And just to be able for us to, well, remember, memorialize po ang kanilang selfless contributions in the fight against COVID-19. And to let everyone know, dito po sa ating webinar po for today and for our future webinars, I'm seeing that we have a little over 800 participants now, but we can accommodate up to a maximum of 3,000 participants in the Zoom. For those who are watching us in YouTube and Facebook, wag po kayong mag-alala, you can still join us and participate sa interaction, pero mas okay po kong nandito po kayo sa Zoom para po mas fully experience po ang ating online community. For those who would want to put any questions already, please feel free to put them in the Q&A box and ilagay nyo rin po kong san po kayo na naon naod doon po sa ating chat box. For those who are asking, lalala po dito sa mga nagtatangang sa chat box, nagdimessage po sa messenger, our certificates of attendance will be given to those who have watched at least 50% of the webinar duration. So we have already completed up to webinar 90, medyo kaya natapos lang po namin yung pang webinar 91. At meron din po mga nagtatangang but hindi po sila nakatanggap, but we will recheck again our records po and hopefully we could get back to you as soon as possible. We will also like to invite everyone, lalala po yung 22 po sa paggasali sa ating fan quiz, pre-test po, hindi lang po sa Zoom po, pero pati na rin po sa mga nasalabas po ng Zoom katalo YouTube and Facebook if you go to www.menti.com and enter the code, when prompted enter the code 30292389, that's 30292389 for you to be able to participate in our fan quiz. We will be utilizing our standard panel discussion format and so we also have our opening remark speaker, our set of speakers for the main presentation, the reactions and then our Q&A session later on. If you are chosen and prompted po to maybe join us in the panel if you want to ask your questions live, hopefully you'll be able to accommodate us doon po sa aming hiling. And without further ado, Dr. Suzie will be introducing our opening remark speaker. Okay, thanks a lot. Thanks a lot Raymond. Ang maraming natutawad yan sa Mentimeter. Siguro sa anniversary meron tayong mahabangan. Okay, so our opening remark speaker is former chairman of the department of rehabilitation medicine of the Philippine General Hospital, three times dean of the National Teachers Training College at UT Manila and also part of the original group that set up the Institute of Aging at the National Institutes of Health. So matagal na siyang nandito sa subject area na ito na aging at kami po ay nakutuwa na na paunakan na tayong lahat to open our webinar today. So I would like to welcome Dr. Jose Alvin Mojica. Dr. Alvin, welcome. Magandang tanghali po sa lahat na participants from Luzon, Visayas and Mindanao. Buenos dias, Buenos tardes, Buenos noches sa lahat. Yesterday, I was pleasantly surprised when my UP Medicine classmate texted me from the USA and forwarded the event poster and said she was attending today's seminar. I suddenly realized and said, wow, we have local and international participants nga pala. So wherever you are at this time, it is a great pleasure for me to welcome you to this virtual webinar series on Stop COVID Dets that the University of the Philippine system has been organizing and hosting every Friday since April 2020. This webinar is part of our contribution to address the healthcare challenges brought about by COVID-19 and to support Philippine society in a time of crisis. As a frontliner myself and a senior citizen as well, I felt so guilty when I contracted COVID-19 after doing hospital rounds then infecting my wife and children even when I was wearing a PPE. Fortunately, all of us had only mild to moderate symptoms that did not require hospitalization, but still all of us were isolated and felt depressed for some time. On the other hand, our younger colleagues have also been having a lot of anxiety but they could cause infection to their children, siblings, parents or grandparents. Indeed, it has been a long time since we have allowed our seniors to go out and interact with others. To be honest, I have not visited my elderly relatives, godparents and close friends for more than two years. But text-text na lang muna, Facebook or Yahoo Messenger. A common question we ask each other is, ano maganda sa Netflix ngayon? As for me, I watched travel videos on YouTube and dream of going to several destinations pag walanan COVID. I would also like to take this opportunity to say again my condolences because one of the earliest victims of this COVID-19 was my classmate, Dr. Kiko Lukban, who's a cardiologist and is succumbed early on during the crisis. While our Department of Health announced that more than 60 million Filipinos have been fully vaccinated, only a small percentage of senior citizens have been fully vaccinated and a much lesser percentage have received booster shots. Compounding this problem is a recent study that showed that COVID-19 antibodies in the elderly declined after three to four months even among those who have received a booster shot. Plus, there appears to be a new variant threatening us again and might come over sooner or later. So the question that we ask is, now that we have moved into alert level one, is it safe for our seniors to go out? In today's episode of Stop COVID-19, we will discuss the status of seniors, the vaccination levels, the condition of seniors that make it difficult for them to be vaccinated and how we can weigh the risks and benefits of going out. Safe nga ba talaga lumabas ang mga senior citizens? Well, I encourage all the participants to make today's webinar a lively, interactive and enjoyable learning activity by joining the Q&A session either through the chat box or after the talk of our esteemed speaker, Dr. Shelley de La Vega and the equally esteemed reactors, Dr. Nina Gloriani and Dr. Ed Poblete. I wish you well and God bless everyone. Okay, thank you very much. Dr. Alvin Moica, and we are looking forward to having you in the panel later. Maganda yung ating special mama yung. Sige, thank you very much. Over to you, Raymond. Thank you, sir Alvin. It's not always that we can get Dr. Moica, so marami-marami sa laman. Sir Alvin po, we will now be, where do we go? So, we will now go po sa ating two questions for our Mentimeter. So, uliting ko lang po, before we go to the questions. We encourage everyone to type in your questions po. If you already have any questions, please feel free to put them in the Q&A or in the comment section po ng YouTube and Facebook po. Parablam po, we will be able to scan and pick and choose which questions will be posed to our panelists. For the first question for our pre-test, ang una-pungkatanungan, isal lang po ang kasangutan, ilang porcento ng mga senior ang nabakonahan na? Is it 84%? 74% or 64%? So, habang nagtatipin po, medyo konti pa lang po ang sumasali sa ating zoom poll at saka sa ating Mentimeter, batayin ko lang po ang mga nanonod from West Layon University, Philippines ikabanatuan CT9-ISIHA from Abra State Institute of Sciences and Technology Embanged Abra from the Senate of the Philippines. Hello po, DSW Haven for the elderly Tanay Rizal. Maraming salamat po, Lubang District Hospital in Occidental Mindoro and Capis Doctors Hospital in Roa City as well as JR Borja General Hospital in Kagayandi Oro in Misamis Oriental. Para po sa ating pangalawang katanungan, okay, ano ang ibig sabihin ng term na healthy aging, so iisal lang din po ang tamang sagot po rito. Ito po ba ay, walaang kahit na anong sakit o kapansanan, option two, kaya panggawin ang mahalaga sa kanila or option three, pang senior citizens lang ito. So, and we will not be closing our zoom poll as we greet our international attendees or participants from Chunin Hospital in Taipei, Taiwan, Bangkok, Thailand, Ho Chi Minh, Vietnam, Bukit, Mertajam in Malaysia, University of Haile, Saudi Arabia, Lunichi Alley University of Lida 2 in Algeria, the UP International Health Nursing and Healthcare Forum in Lexington, Virginia, those from Monina from Stockton, California and those from Edmonton, Alberta, Canada as well as St. Eustaceous Oxillary Home Foundation from the Netherlands, Antilles. So, maraming-maraming salamat po. Alam ko po, medyo iba-iba po ang time slot kung baga sa kunasan po kaya but we are really very appreciative of you taking out the time to join us for our webinar. We will now move on to our webinar proper and Dr. Susie will introduce our very first presenter. Okay, thank you very much Raymond. Parang nagtatagal sila do sa unan tanong kasi puro four eh, di ba? Four? Ano 64? 84, 74, 64. 64, okay. Sa sabi ko parang walang sumasag, but nag-iisip talaga sila. O makanda yan para malala natin kung anong tamang sagwata. So we are very pleased to present our first panelist and you know her and you love her. We've always had her here. Siya po ay, ano po ito eh, siguro sabihin natin pioneer sa area ng geriatrics o yung pag-alaga po ng mga maslangakaitad and she set up the Institute for Aging at the National Institutes of Health and she really loves seniors and understands them very well. So napaho say po na Dr. Harvard trained ito si Shelly DeLaVega classmate ko po yung. Siya, I'd like to welcome Shelly DeLaVega director of the Institute of Aging of the National Institutes of Health. Hi, take the floor. Hello, thank you for that kind introduction. Dr. Susie, classmate, Sir Raymond, director Raymond and of course, Dr. Agni Mohica for that wonderful opening remarks. Let me now share my screen so we can start our discussion on that question. Pwede lang abalumabas ang mga senior citizens na po. All right. Am I okay? Okay na, Shelly. Okay, thank you very much. So let's try to answer this question. You know, you presented some videos of people around, no? And I also had a poll of my high school classmates. Ano, takot ba kayo? Lumabas and more of them are still afraid even if they have been fully vaccinated because they know that many people are not yet being vaccinated. So yun ang kinakatakutan nila kahit na nabakonahan na sila. So let's try to answer this question. We are now aware of the devastating consequences of COVID-19 on people with multiple comorbidities and advanced age. Most deaths from COVID occurred and are still occurring among older people as seen in these numbers from our world in data at age COVID tracker dated 16 March 2022. It shows that although most cases reported are among young adults, most deaths still occur in the older age group beginning at age 15 with the highest deaths among those 80 years and older. So let's talk about age and the risks of COVID-19 complications. Why is it happening? Before COVID started the Fit for Frail study of 355 older people in four barang guys representing the four regions in the Philippines which revealed these comorbidities known to be associated with a higher complication rate and deaths from COVID-19. 55.6% had hypertension 16.8% had diabetes 15.4% were obese and 11.6% mostly men smoked tobacco. Other risk factors increased their vulnerability are living alone or being socially isolated and being dependent on others or needing a caregiver. Frailty something that we associate always with older people is that photo of an old person using a cane bent over or using a wheelchair so that is really a frail older person. Now frailty is defined as reduced strength and physiological malfunctioning that predisposes an older person to increase dependency, vulnerability and death. The frailest are at risk of COVID complications, hospitalizations and death and in the Fit for Frail study we noted that only 15% will frail and especially those among age 80 years and older. In fact 44.2% in the oldest age group had a caregiver and were already dependent on others. However in that study a great majority were not frail. 19.3% were robust and 60.5% were pre-frail. Dementia is a general term for loss of memory, language, problem solving and other thinking abilities that are severe enough to interfere with daily life. In the Fit for Frail study pediatricians adjudicated the diagnosis and it revealed that after undergoing the Montreal cognitive test and a comprehensive geriatric assessment 24.4% of our participants had some form of cognitive impairment and 9.1% had dementia of which 3.2% were of the Alzheimer's type. Now people with dementia are at a higher risk of COVID complications because of the following reasons. They have difficulty understanding the risk of leaving the house. They have difficulty following minimum public health standards such as washing their hands and using a mask. Isolation increases their behavioral and psychological symptoms. They become more confused and agitated. In fact kahit tayo wala ng dementia kung insan we feel that our memory is somehow more muddled during COVID isolation, di ba? COVID patients with dementia are prone to acute worsening of confusion called delirium and studies by neurologists all over the country and in the world have marked this increased risk of delirium in hospitalized COVID patients. They are fearful but are unable to express their fear and there are communication barriers that makes it difficult for them to report symptoms or seek timely help. Now as of 27 February this year the IATF guidelines on the nationwide implementation of alert level system for COVID-19 response defines alert level 1 to be referring to areas where in case transmission is slow and decreasing. Total bed utilization rate is also lower and intensive care unit utilization rate is low. So let's remember it as this. Let's assume that because we are at alert level 1 transmission is slow and decreasing and there is low utilization rate of hospital beds and ICUs. Okay. So alert level 1 also requires the prevention of COVID transmission which includes for health facilities administrative and engineering controls including infection control practices. Communities are required to support mental and psychosocial needs especially of the vulnerable groups and make available context specific and localized health and safety education materials. DOH and healthcare providers need to set up a mechanism for provision of care and referral for patients with symptoms or other emergency health conditions. So let's assume that these are all in place. So aside from these minimum public health standards administrative and engineering controls vaccine coverage also needs to be at least 70%. Okay. However in my opinion, we also need to provide a supportive environment that supports healthy aging after all we are in the decade of healthy aging, di ba? Until 2030 and assure that our senior citizens are healthy in body, mind and spirit. So how do we go beyond COVID approach and achieve healthy aging? Now let's first define healthy aging. Healthy aging is the process of developing and maintaining the functional ability that enables well-being in older age. It takes on a life force perspective. We accumulate strengths and deficits across the life force and functional ability is that ability to be able to do what is meaningful to you. So yun ang sagot dun sa ating question na una it stems from the interactions between our intrinsic capacity or partly from biological aging and environmental factors including a supportive healthcare system. Now function and our intrinsic capacity are best when we are young. But these steadily declines as we age. Acute illnesses such as COVID-19 can result in a rapid decline in functioning. However, if we have a supportive environment that decline in functioning may be avoided and functional ability can be extended and even maintain despite intrinsic aging. So that is what I want you to understand about the longitudinal perspective and trajectory of functioning and functional ability in healthy aging. So let's talk about cases because there are nilaman magkakapareho ang elderly. Aging is an extremely variable experience. So when you say can senior citizens go out during level one there are various kinds of senior citizens. Like I said earlier, there are the frail, the pre-frail, and the robust. So let's talk about Mr. Wilanko. Invento ko lang yung pangalan ya na imprehin, hindi yan ang tutong pangalan ya. Let's call him Mr. Yu. But he represents a patient that I have encountered in my geriatric clinic. So Mr. Yu is 95 years old and suffers from Parkinson's disease and needs assistance in all his activities of daily living such as feeding, bathing, dressing, and toileting. He has been confined to his wheelchair in his home since the pandemic began. However, despite Parkinson's disease, he remains mentally alert and enjoys activities such as watching TV and talking to his grandchildren online. He lives with his daughter who now asks you if she can bring her father outside now that it is level one. He has not been vaccinated because his daughter is afraid that he may get COVID from someone in the vaccination center. So should Mr. Yu be allowed to get vaccinated? Let's think about that question. And let us now proceed to healthy body COVID prevention through vaccination. The answer, of course, to case one is yes. Mr. Yu is frail but will benefit from vaccination and booster. His dutiful daughter needs to arrange a home visit vaccination through their Barangay Health Emergency Response Team or senior citizen coordinator and after his vaccination provide tender loving care and make sure that his needs are addressed. In case, he has some problems with pain in the vaccine site or some problems with the vaccine if ever. But let's look at the health system and vaccine coverage based on the recent statement from WHO Philippines. They say that we need to achieve the minimum vaccination coverage target of 70% to protect those most vulnerable to COVID and its complications. However, 2.4 million senior citizens have not yet received a single dose of vaccine. Vaccinating the vulnerable which includes the elderly is an absolute priority. And in order to improve vaccine coverage they say that we need hospital, house to house and close to home vaccination drives and that is what we have been promoting for many, many months now. Okay. So in the fit for frail study we found out that before the pandemic 54.1% of older Filipinos were never vaccinated against routine flu and pneumonia vaccines. It is good to know however that most of these vaccines were available and administered in government hospitals and RHUs. In that policy brief of ours we recommended that we need to develop educational materials on vaccination for older people close monitoring and follow up of their immunization status and to amend RA9994 to expand vaccination to all older people age 60 years and above and to improve access to these vaccines health centers and private institutions. Now let's go to the second case Mrs. Gomez. Okay. Mrs. Gomez or Mrs. G is an 81-year-old owner of a carinderia she is obese and has fairly controlled diabetes and hypertension. In general, may control sometimes at papadami ng kain kaya tumataasang sugar and blood pressure. She had her two doses of COVID vaccine after shot. Now that it is level one she plans to attend her usual social gatherings especially to get back to being actively serving in her carinderia her carinderia customers and resume her church and volunteer activities. So the question is is it safe for Mrs. G to go out and resume her pre-pandemic work and volunteer activities. Okay. So I missed ka ko and the answer to case two is yes. Despite her medical condition and age are fully vaccinated Mrs. G is robust she is considered robust and may resume her work in her carinderia provided she uses a face mask washes her hands frequently and provides good ventilation in her work area. She also needs to follow up with a specialist to ensure that her medical conditions are better managed and controlled. She may do this medical consultation through tele-consentation or go to clinics now for face-to-face encounters with her physicians. So let's now look at COVID-19 risks and vulnerabilities again based on that study that we did among older persons. There are COVID risks and vulnerabilities that I mentioned a while ago among older persons and there are multiple opportunities to create a supportive environment especially improve the health system. We need geriatric programs and services to enable the health system to achieve healthy aging and respond better to challenges of older persons during disasters and this pandemic and after this pandemic. So our recommendation in this policy brief is to promote healthy aging programs such as the National Health and Wellness Program for senior citizens which includes a comprehensive geriatric assessment, fitness, nutrition and vaccination programs and align the delivery of these services of health in health facilities and through regional health units with universal healthcare. So let's align this with universal healthcare. Now fortunately the good news is that DOH recently launched the health and wellness program for senior citizens manual of operations for local implementers as well as a geriatric training for primary health service providing training of trainers module. So nagtatrain na getting ready na at DOH. Both include sections on dealing with COVID-19 and give they both give emphasis to universal healthcare. So we have something that we really look forward to. Now let's look at digital connectivity di ba sabi ko pa ni na our patients can connect with their doctors now through telemedicine. Now we did a study called UPMWISE at the start called UPMWISE in Dilliman and Osvanyos. These are former employees and retiring no, hindi pa naman retired but retiring faculty and employees of Dilliman in Osvanyos and we found out that cell phones are the most commonly used gadgets for social networking, email and obtaining information regarding work na. In Osvanyos in particular 94% used their cell phones. 58% had a laptop and 37% had a desktop. At the start of the pandemic and while we were rolling out the vaccines we experienced, we realized that most senior citizens had no medical records. In the Barangay Health Centers and many had difficulty getting a medical clearance from a physician kasi hindi naman sinang nagpapakita ako nagpapakita maan, wala man silang record na madaling it transmit through cell phone, viber or whatever kasi na we were in lockdown. So Mrs. G, like many older persons, is adept in using her cell phone and we can easily train her and many senior citizens on how to use digital means of accessing healthcare and health information. Okay, now DOH has been very active in producing health and safety education materials online and these are accessible to many who use na are able to use websites and these, if you can see, feature senior citizens. Unfortunately not all senior citizens have access to cell phones or laptops and wala silang panglod. Furthermore, we need to look at the health information system for older persons. In that same study, we found out that there are health information issues that need to be addressed. In a publication by Garcia de la Vega and Dr. Mercado here, we found out that medical records exist for most but were not digitized for many. There was no comprehensive geriatric assessment and there was no individual EMR for older people and at the moment, health information systems for older persons is fragmented, come from multiple sources and is inaccessible in general. So hindi natin siya magamit, di ba? Sayang ng pandemic when we were wanting to list them down for vaccination and get them into the system. Wala palang danong systema. So let's now move into your case. Mrs. Wakin, is an 81 year old widow who has recently become more forgetful and confused specially during the lockdown. She never had tests for dementia. Before the pandemic, she was advised by her doctor to get a CT scan of her brain and a 2D echocardiogram because she also had some problems with getting short of breath. She is now fully vaccinated and boosted but her children want to know is it safe for her Mrs. Wakin to go out to a hospital to get these tests done? Okay, let's answer that question. Let's talk about the healthy mind or mental health during level one and during the COVID pandemic. The answer of course is yes. She is fully vaccinated and boosted and she is pre-frail. Mrs. J is a classic example of a pre-frail older person and we want her to get optimal care and she may safely go to a hospital to get her tests done despite her memory loss and confusion. Most hospitals now adhere to and have administrative and engineering requirements to reduce COVID transmission within their premises. She needs to be accompanied however until we'll remind her to keep her mask on and to wipe her hands with a sanitizer as often as possible or even better to wash her hands before and after encounters in the hospital. Now we looked at the mental health needs of senior citizens in that fit for fail study and mental health data from our study revealed that none of our participants reported mental health issues. However, after that cognitive test as I mentioned earlier 9.1% had dementia diagnosis. Now many of our participants reported mental health symptoms such as memory loss, depression, anxiety. In that same study 11 out of 16RHUs were found to provide free counseling and psychosocial services to older persons. So mayro naman pala. In the many in the 27 hospitals that our team visited and there were only now 160 certified geriatric strands all over the country. We'll hear from Dr. Ed Poblete nandagdagan naman na siguro. So what does this mean to us and mental health? Now we realized through scientific evidence recently that there is now a convergence between COVID risk reduction and dementia prevention about related palayan. We can reduce neuropathological damage and reduce COVID risks through three common things. Through minimizing diabetes treating hypertension smoking cessation and reducing midlife obesity. If we do this pala and help our patients achieve this we can reduce their COVID risk and reduce their risk for dementia. How nice to know, di ba? Now recently we had we achieved some funds from the WHOV pro-mental health unit and there are now resources on dementia during the time of COVID a project of the Institute on Aging and you can look at our links here et cetera on some of the lectures that we gave concerning this topic. So please access these lectures on YouTube. Now so how do we sustain a supportive environment for senior citizens during and after the COVID-19 pandemic para nakakalabas di ba nakakalabas and safe and comfortable less anxious for senior citizens. So let's talk about the health systems for older persons in that same study fit for fail. We found out that health services specific to the needs of older persons are available but variable especially in hospitals and health centers. Most services are outpatient based. In fact inpatient services are not specific or comprehensive for older people. Sadly nobody was able to access a public service and remember during COVID home care services became so very important wala pala ang public or at least something that is funded by field health wala palang ganon sa home care service. The lack of trained staff who can implement programs for older persons is also a major constraint of the health system. There are not enough mental health staff trained in geriatric care and insufficient budgetary provision for health services for older persons in government facilities and the health care system is unable to meet the needs of older persons in relation to leading causes of morbidity and burden of disease. Especially a lack of medicines and services for dementia. Now hindi lang naman siyempre DOH or government we in the community have a role to play. Older persons may safely go out in level one areas and our communities have to be age friendly and that means social support protection against discrimination and ageism, protection against violence and abuse, continuing education and literacy program spaces to walk and be active sabi ng isang na video natin kailangan na nilang lumabas at maglakad, kailangan nang mag-exercise, maarawan and we need enabling technology and regulations for all of these. Older persons are encouraged to volunteer and mentor activities that they can do with family members and friends online or face to face now that we are in level one. LGUs and especially Byron guys can help support seniors who are home bound by checking in on them daily and helping deliver food and medicines to them. So let us achieve and we can achieve healthy aging despite the challenges of COVID-19 and beyond this pandemic. You may contact and follow us up through these numbers and social media platforms. Thank you to TV UP, Stop COVID Deaths, Organizing Committee and to you our audience and to all of the participants and researchers in the Fit for Fail and UPWISE research programs. Thank you very much. Thank you so much Director Shelly. Marami po ako natatunan dun na at lalo na po doon sa aking focus which is your publication with Dr. Susie. Marami-maraming salamat po. Dr. Susie. Salamat po. Oh Raymond. Okay. Okay. Amute Kayatay. Thank you very much. Thank you very much Shelly. I'm sure our audience has a lot of questions and as always it was a very comprehensive very tight presentation giving us a good way of framing framing these issues. Hindi patay-pantay lahat kailangan marami tayong ibang mga hindi isip. Agusapan pa natin yan. Sige Raymond, introduce natin ang next speaker natin. So kinrem. So kay. Thank you Dr. Susie our next speaker po. Kailala nang kailala nang po ito. Well she used to be the Dean at the College of Public Health at University of Philippines Manila but for our COVID response talagang may even in the interviews po mayagit ninyo po si Dean Nina because she's the chairperson of the D.U.S.D. Vaccine Export Panel po. So without further ado we'll call in Dean Nina Gloria ninyo po. Yes. Thank you very much Dr. Raymond. Good afternoon sa inyong lahat. Dr. Susie, Dr. Aldi. And ito lahat. And of course Dr. Shelly thank you very much for that very comprehensive presentation. Of course is sa summarize ko lang nang para do sa reaction ko. I have eight slides lang naman. Go ahead mam. Better. Tika lang. O yan. Tika lang. Ano po to ayan. Saif nangaba lumabas ang mga seniors. Well senior ako. Gustong gusto ko na rin lumabas. Sa alert level one tayong ngayon hignan natin. I put this together yung TV, UP and other questions that to me would need clear simple answers and actually marami nang sinagot si Dr. Shelly. Pero let's just put them together again para mas I hope mas simple. So yung una is how safe. Safe nangaba. So we have to do resacestment. And a lot of resacestment was already explained by Dr. Shelly. We have to weigh the risks and benefits of going out for seniors and she gave us three cases studies. Pero siguro dahil na sa vaccine program ako. I'll delve more into the status and vaccination level of senior citizens. Question. Have most of the country's senior citizens been fully vaccinated and boosted already? So and it is a good question. National coverage for a two full vaccination is currently ngayong March. March nine yan. At 74 percent. So at least mayang pan 36 percent that remain unvaccinated or partially unvaccinated. And mayang mga 45 percent na boosted. I'm sorry baka hindi to 45. Okay anyway. So ang question is are older people entirely safe just because they are vaccinated? Pwede di itanong yan? Safe nang ba? Bako nado na ako na didignating kanina do sa mga interview sa ano. But should people around them be vaccinated as well? And for the unvaccinated na mas o yung una yung vaccination. Then yung mga hindi pwede o ayopao may konting hesitancy pa. Are they at least contracting the virus? Of course, definitely yes po at sagot yan. So it all this is also a favorite slide of mine. Makikita natin yan. The unvaccinated who get COVID-19 shared more viruses for longer periods than those who have been vaccinated and got breakthrough infections. So makikita nyo ito pung red yan yung mga that's, that's yana red. Yan yung mga viruses na mas marami kapag unvaccinated yung nagkakovid versus yung may vacuna. Ito nandito lang sila. And then longer marami ang virus na natatransmit nila sa iba at mas mahabang panahon tinatransmit nila yan. And then we should not forget kaya nga medyo tumaga tumaga in pandemiya ay because of the variants of concern the variants of interest kung ano ano pang mga variants that are emerging especially we now looking at the Omicron. At meron po tayong Omicron original Omicron variant pero meron din po sub variant ito po yung anak ni Omicron. Now this is actually affecting Hong Kong right now. Actually meron tayo siguro na o hindi pata hindi masya dung clear yung atin genetic kung ito ba ay yung sa atin ay BA.2 or .2 meron pa silang ko ano ano jano just look at this the original is called Omicron BA.1 pero may mga anak siya na iba iban tawag ng iba ibang scientists but what is clear is that it may also come in if it has not come in and this happens to be more transmissible than the original one or the other question is could other variants emerge that are even more transmissible kasi habang meron po mga tao na yung transmission habang transmission goes on while it goes on there is that probability higher probability of the virus mutating so pagnagmutate ito na naman si variant so could this variants be more even more transmissible right now itong BA.2 30 times more transmissible now or some variants would cause more severe disease ayo na ayo siyempe natin nyo or actually some of these variants already showed that they could evade vaccine induced immunity or even natural omic immunity from original strains so ito ang ating considerations pinup together ko na lang ito vaccination status sub-senior ang tanong nakaful vaccination ba sila partial lang isa lang dapat dalawa meron naman isa lang dose pero kung dalawa kailangan dapat dalawa so partially lang sila immunized or na ka-received na ba sila at least one booster dose kasi there are considerations for a second booster at this time so ito ang din natin ang vaccination status ng community kusan siya gumagalaw ito ang ating senior ang immunization coverage importanti ko yun then we look at their own recent vulnerabilities yung kanilang health status level of immunity the comorbidities and extreme age as already expounded by Dr. Shelly we had to scan the environment the COVID-19 prevalence in areas to be visited by our seniors condensely populated by young open-air by young profile of the people our senior will likely meet and the duration of exposure outside kung gathering ba ito party, meet-up or short ano lang na mano meet-up then what activities to engage in what to allow and what not to engage in and very important is the use of protected gear so where PPE preferably well alam naman natin ang mga surgical medical or kail lalo na kung better ko N95 mask especially for the elderly and then the minimum fabric of precocious so in short parang what I'm trying to say here is there has to be parang a matrix go or no go depending on all of these vaccinations factors, recent vulnerabilities the environment activities and of course yung kan aware ng PPE so I have been presenting this in many webinars makita nyo ito yung sagot nga 74% this is national vaccination coverage per priority group as of March 2 na sa 74% ang A2 so medyo pwede na yan pero makita nyo napat na sa green yung green ay yung A1 A1 ito yung mga outbound and understandably talagang immunization lahat and then yung A3 na sa 93% pero si senior na sa 74% we do not worry about the others yet kasi kabab kaya start lang na sa mga pediatric pero merong exposure ang mga senior citizens to the pediatric age group who have not received their vaccination so we have to consider higher vulnerabilities to COVID of course due to old age plus their attendant comorbidities so ito na ako lang from WH pero last year pero it speaks of how well the different regions of the Philippines actually immunize their people so NCR I think is still best 90% na tayo 93% but we have to consider others na na sa red especially barm so I just wanted to include this ito is a very nice paper on UK observational study on the characteristics of SARS-CoV-2 infection after first and second COVID-19 vaccination so it highlights the need to complete the vaccine and also maybe to give the booster so just some of the salient points some individuals will become infected this is clear na that some individuals still become infected after vaccination ito iti na taong natin breakthrough but vaccination compared with no vaccination showed reduced odds of hospitalization or having more than five symptoms graveyo ka nilang study pato yung mga symptoms binay lang nila in the first week of illness following the first or second dose and long duration of symptoms following the second dose so comparison of the vaccinated versus the unvaccinated now almost all symptoms that they actually reported that were listed were reported less frequently in infected vaccinated long in infected unvaccinated individuals and their data showed also or suggested that frame all their adults and those living in more deprived areas are at increased risk of yung mga complications of COVID the study found that frailty was associated with post-vaccination infection in older adults or the 60 years after their first vaccine dose especially so adverse determinants of health such as living in highly deprived areas including obesity were associated with an increased likelihood of SARS-CoV-2 infection following the first vaccine dose now they have this data also that show that vaccinated participants who got COVID breakthrough were more likely to be completely asymptomatic especially if they were 60 years old kasi nga bakunado either asymptomatic wala meram daman pero may contain virus na nakuha or may may mild symptoms but for those who get symptoms COVID-19 appears to be less severe and we have seen this Dr. Shelley has said this less severe in vaccinated versus unvaccinated individuals strategies such as timely prioritization of booster vaccinations and optimized infection control measures should be considered especially for adverse groups so I managed to get some photos these are all the photo credits to CNN Philippines ito yung naging alert level one na paglabas ng ating mga kababaya of course may young may old pero may kaito nyo may mga old ang issue ay para bak ito alert level one or alert level zero kasi in alert level zero sige sige lahat lahat normal some with masks properly worn but others no anak so so what I'm also saying here is there should be careful very careful consideration of scenarios for seniors who will be allowed to go out of their homes so don't take home messages protection of the elderly seniors in vulnerable communities it's very important and their alert level one conditions where quarantine restrictions are relaxed and where more people are allowed to go as panel member of the panel the vaccine expert panel we really have very good data on the role of third doses or first boost ito so booster doses they should be considered not just the primary doses for added protection especially with the omicron driven surge so roughly only around 9.7 million less than 10 million Filipino adults have received booster doses as of february 22 and we are targeting 72 so mayong patayang 60 million na hahabulin sana in order to really protect us and provide us not immunity wall that we have been talking about so being a heavily mutated bias alam na natin ang omicron the protection we got we get from two doses not enough to protect us against the omicron adding a booster dose would retain our protection as shown in many many studies especially against b8.2 the more contagious version of omicron so as a public health persona talagang the crucial role of masks so I don't think I will throw away my mask even for the longest time and for everyone well fitted face mask should be worn properly at all times whether outdoors or in indoor private or public establishments including in public transportation by land by air by sea of course except when eating and drinking and while participating in other activities so yun lang po and I hope our seniors will all be able to go out but we have to consider the risks versus the benefits and of course the importance of having everyone vaccinated and boosted salamat po okay thank you very much that's former dean of the college of public health Dr. Nina Loriani ang ganda ng tandem nila ni Shelly parang nakafocus naman si Doc Nina dun sa the role of vaccination okay so we're going to have a speaker now from the private sector it's my pleasure to introduce president of the Philippine College of geriatric medicine he's also head of the geriatric center of St. Luke's Medical Center in Quezon City we'd like to welcome Dr. Eduardo Romel Poblete welcome Dr. Poblete thank you thank you for inviting me here Dr. Susi thank you Shelly for that informative lecture that you gave it's tiny that you open up the concept of frailty among the senior citizens it's a worth noting that indeed the status of their health is a big factor in answering the question whether wedi na lumabasa mga senior citizens just a few notes on this topic we the private sector have been quite confused on certain data that has been coming around for instance on the population of the senior citizens of the Philippines there has been some discrepancy in numbers we know that as early as 2020 May based on the Philippine census and population and housing there's around 11.31% senior citizens out of the 109th class Filipinos that's roughly translated into 12.366.355 and by the age of counts based on July 2021 which is last year as reported by the WH Western Pacific report there's about 8.5 only senior citizens in the master list so this actually gives a lot of confusion in the data that we have but it's quite comforting that Shelley has very new and updated data especially on the status of healthcare in the Philippines true we need to classify the patients and consider how frail they are or how robust they are before we even think about the question of whether that the senior citizens are the most hardly hit by this pandemic the severity cannot be over-emphasized and in 7 out of 10 that's that is attributed to senior citizens until I think today that's true and the higher COVID-19 we know that the curse among senior citizens is because of their age the physiology changes that they have to undergo like chronic diseases immunosin essence or aging of the immune system there is more severe inflammation and therefore more severe organ damage is expected there's also the aging respiratory system and comorbidities that may be responsible for even long-term complications in these patients now unimportant note that we important issue that we want to take up also is about the immunization of senior citizens the Taraninas presented so much about data on the vaccination status of our senior citizens and however I came across a study that's very interesting is just published in January of this year about the hesitancy in COVID-19 uptake among six asian nations including the Philippines why are patients a bit hesitant in having their vaccination first may be the primary series or the booster and they saw the relationship between age and that hesitancy even the social economic status even the residents of areas where the urban are more likely to have the vaccine as compared to the rural areas in education where the of course the higher the education the more the less hesitant you become and even employment so that the unemployed are less likely to have the COVID-19 vaccines in age there is an increasing hesitancy as we grow older that was a relationship they had in social economic status is surprising because the higher the social economic status the more hesitant you become meaning there are more rich people in the Philippines who do not want the vaccine or hesitant even the first series so what are the recommendations from our end from the teleactive community we suggest that we have a targeted strategies in these immunizations we should have more vigorous outreach programs that may include education now that we have the multi-media system we must increase the access how we must offer the government may be able to offer vehicle services for the senior citizens who are hard at walking or who have difficulty in performing the activities of daily living there must be senior liens that are exclusive and even seniors only vaccination dates and of course the most practical house to house by the barang guys so we cannot overemphasize the importance of immunization at this point in time where we by our estimates we only have about 7.7 million at about 62.8% primary series completed based on the recent announcement of their age in March 1 that only is 62.82% of the primary series have been completed in about 7.7 million adult or older older adult in the Philippines so we hope that you can join us in convincing our seniors to be more to be less hesitant in having the COVID-19 vaccines so that we can easily answer unconfidently answer the question of pwede nabasila nababas for easily and say yes they can so, salamat po sa and for the answer to Dr. Shelly's question of whether we have we have improvement in the services yes I think we have more geriatricians now than ever very close to 200 now and we have increased by four more the training institutions around the Philippines now so from the Lone St. Lux Medical Center in Casun City we now have training in the Global Center in Global St. Lux we have now in National Center for Geriatric Health under Jose Reyes we now are training in National Center for Mental Health and of course we are going to open one in Batangas City so thank you very much again Doris, we'll see back to you thank you very much that's Dr. Eduardo Romel Poblete who is president of the Philippine College of Geriatric Medicine and we'd like to welcome all the members of the College of Geriatric Medicine who are watching watching today okay so we are going to ask our panelists to open their their video we're going to ask Dr. Poblete Dr. Nina Dr. Shelly and Dr. Alvin to open your open your your videos we're going to have an announcement from Raymond before we go into our panel and for those of you who have questions please put them in the Q&A box or in the chat so I've seen a number of questions very interesting questions already but now's the time to ask your questions okay so Raymond over to you thank you Dr. Susie and thank you also to president Ed Poblete of the Philippine College of Geriatric Medicine before we proceed with the Q&A let's just take a very very quick break for our special public service announcement oh si Ginana parang kagat lang lang gam hantik o yung kumikilitilang ito naman parang hindi ka pa nababakunahan dati akala ko pa naman brave girl ka nakakahiya na kaydo okay lang po nana ay ay ang cute naman ng shirt mo favorite color ko rin yan top favorite ko ang color nito ayoko po ng red hantik masakit kumagat at takot rin po ako sa blood magtutugo po bako sa bakuna ah hindi wala hundugo sa bakuna kontin pisid lang tapos na kakasugat bako do di ka magkakasugat lalagyan lang natin ng plaster pagkatapos para safe di ba nabakunaan ka na rin ng contra measels at chicken packs dati parang ganun lang din ang bakuna para sa COVID-19 natatakot parang nakodok alam mo ang secret sa pagiging brave hindi ibig sabihin na wala kang kinatakutan kundi kahit natatakot ka hinaharap mo parin nito okay ready na po ako doc una pupunasan ko muna ng bulak na may alcohol ang brazo mo okay tapos mabilis lang na konting ayos tapos tapos na na pwede mo ng buksa ng mga matawo nai sabi sa inyo brave girl napuakaway oh heto ang price para sa iyo ha wow bagay sa shirt mo that's the color of bravery colorin yan for love thank you doc thank you nai dahil ako po ay mahal ninyo nagpabakuna na ako eh mga bata magpabakuna na kayo stay safe and stay well mga bata magpasama na sabakuna center thank you so much tvup the covid communication public service announcement it's one of the many creative outputs of the stop covid death team to push for pediatric vaccination for children age 5 and above we hope that this message is something that will be carried on by parents and guardians so that the children could be protected against covid 19 over to you dr. Susie parang ka-boses mo yata Raymond yung doctor doon sa cartoon na yung okay so anyway okay so we'll have our first question for our panelists and Raymond is of course scouring the questions from both facebook and youtube and also from the q&a but let me just ask a simple question for all our panelists because it's okay hindi parip-pareho lahat ng senior but let's say in general let's say meron tayong senior malapit na yung mother's day di ba gusto kumain sa labas for example what are the considerations what would you consider red flags wag dito sa lugar na to di ba in general wag sa lugar na to because of what okay so i'm going to start with dr. Poblete i'm sure you get that question from your patients go ahead yes yes well i've encountered those questions they are very practical ones and usually we advise the patients to try to consider places that number one hindi crowded okay yun yan mga external environmental considerations but of course wana-wana i consider nyo po is status ng paciente is the patient up to it bukod sa sabihin may immunization na yan or kakaroan lang niya ng COVID about two weeks ago and now she's okay she's been cleared okay so meron mga internal factors sa paciente alimbawa on that day nagkaroon siya na si por ubo like that something that's trying to derail the function of the patient we advise them to better not to it to try to reconsider maybe some other time or maybe just nga lang sa bahay or baka mas pabute na ilimita lang yung kanyabunang movement to people who's taking care of her and best to wait for her to recover kasi ang masabili siya mga kakarikora I think kapag hindi makomplikit yung kanyang sakit and then yun sa mga external din is how long is it going to be for her to reach that destination baka na mga kasi meron mga ibadic salivate out of town that's going to take a toll also on the seniors narunin mga out of town again nyo tapos wala break wala malang toilet break wala maganon hirap na hirap na yan pagod na pagod na yan and the nurses will also take it's toll pagganon buyat pa hindi pa silang makatulog out of excitement tell aro aro pinapaalalan malapit na malapit na nag-anticipate na yung matanda oh ay naman correct correct anticipate na sila alam yun naman sila yung matatanda hindi po'y ding bahule hindi po'y ding maano dapat maagat tayo sa oras maagat tayo okay so these are factors that will remain unanswered until you look at the patient and talk to the family a little bit more in-depth about any activity that might potentially potentially harm the patient not just for COVID infection but on other diseases as well so it's a general answer to a general question about movement of seniors around so salamat po thank you dr. Poblete we're gonna hear from dr. Alvin na isip ko tulay ali ka magmiranda tayo sa bagyo di ba okay dr. Alvin go ahead what do you think what's the general what are the general considerations for eating out I think it's important yung anano yung mga kasaman yung sa bahay kasi for example my wife always prevents me from going out of the house although lahat kami bakon natin ay but there is still that anxiety kasi di namin makalimutan yung time na nakasakit kami lahat and we isolated ourselves and we quarantined ourselves for a long time di namin somehow it leaves a mark di namin makalimutan kung anay naramdaman mo noon and he wouldn't want to experience that again so siguro yung mental health ang psychological factor is very important na ma-overcome kaya ngayon ngayon na napakam marami kaming taon nakikita o kaya pang may umubulang nakatabimu talaga natatakot ka pa rin ay kaya nalam mo mga ay natayo ka na natayo ka na lalo na sa simbahan pag nasa simbahan ka ng misa tapos may umubu-ubu din sa likod mo sa tabimu yung tapointis dapat siguro yung alay natin yung anxiety kasi yung one chef experience the symptoms hindi mo mga wala tapos alam mo nandyan pa rin naman yung COVID I guess we have to overcome that Parang it's ano para siyang PTSD para post-traumatic stress lalo na dun sa mga nag-COVID within the family Shelly, what would you like to say? Let's talk about PTSD That's very true PTSD after severe COVID especially those who were hospitalized or were in the ICU That is a true event that we have encountered Of course, there are ways to deal with that kailangan talaga na counseling Jan PTSD Pero anxiety has been heightened also during this COVID pandemic madaming anxious madaming datay hindi naman masyadong OC na OC din na Pero in contrast naman wala pa tayo sa level 1, level 2, and level 3 Sorry ya Nagpunta kami sa isang masarap na restaurant sa Tagay Tagay ang sarap talaga duni Aba ay may mga matatanda dun na wheelchair kumakain Aba? Nakasa na na obyata talaga di ba Doctor Gloriani Ayong malalakas na loob Hindi ko naman siya na discuss as a case Pero ang pinakam malakas na loob na senior citizen ngayon na lumabas at lumala ba sila maniwala kayong ayong mga nabakunahan at nabuster na at nagkakovid at nagrecover ang ulakas ng loob nilang lumabas at sa aking naman basta naman mag-face mask facial tayo and all of the things that Doctor Pavletti mentioned sa precaution and Doctor Gloriani had this beautiful table of what to look out for I think it's safe for them talaga kasi may mga taon na mga talaga dahil sa matanda na sila naranasan niya lang lahat Hindi na sila takot mamatay Hindi na talaga may mga hindi na talaga takot mamatay kaya ngayon nung nasa mall ako ng isang weekend isang magandang mall damig na ka wheelchair na mga matatanda paikot-ikot na sa mall So it's really also their choice di ba? Yeah, thanks Shelly I was going to ask Nina from the point of view of maganda yung ke Shelly malakas ng loob nung nabakunahan at nagkakovid na So Doc Nina, if you have had COVID and you've been vaccinated twice plus booster mas malakas madapat ang loob mo? A ha ha ha Sa Indog siya ang tama ayo kasi mayroong tawag na hybrid immunity yun na better than natural immunity alone or vaccine induced immunity alone kita yan sa mga data na talagang kung mayroong natural immunity binigay mo pa ng vakuna kaya nga ni recommend namin yan nung nagkaroon ng mga COVID wala pang vakuna na may data sila that showed na yung seropasitive mayroong immunity dahil nagkakovid nung binigyan, isandos lang at that time ay gumanda wala yung kanilang naturalizing So hybrid, pero wakay magpapa-infect para lumahakawa na hybrid Pero Doc Nina, despite that, That's true kasi yung mga variants ang arting Sige, okay, let's go to Raymond Raymond, ano bang napili mo na harvest mo questions? We chose, I think the question that is most top of mind for those kasi we see this in the YouTube po on the Facebook. The question, and we'll post this to the chair of the VEP Question po, mam Nina is at least apagusapan yung napubay ito Do senior citizens need a second booster dose for them to be allowed to roam the streets et cetera, et cetera Doc Raymond and everyone, actually meron na huming recommendation pinadala na namin niya sa FDA I think the DOH knows about it kaya lang pinagusapang pa at the level of the all experts group kasi may mga levels tayo ng experts tapos, kindi lang kinokonsider yung technical, plus yung mga social economic benefits kasi ang gobyarno ngayon ng bumibili ng mga bacuna sa may mga cost ano din yan, pero I'm sure na eventually in a few days makasana lumabas na, a second booster lalo dahil sa Omicron Okay, mam Nina to be clear the recommendation of the VEP is yes. Okay, okay po Thank you mam Nina. The other one and I think this is siyempre nung mga bago-bago po yung COVID and it's something na medyo nakasanayan na po and up to this day I think it's a ritual. When you go out, you immediately take a bath or you remove your clothes segregated et cetera, et cetera The question coming in from Celia Balbin from UPnismed is ganun pa rin po ba ang dapat gawin importante po bang ganun ang gawin even if you're not coming from the hospital baby you just went to the mall or something Pwede nang mag-maligo Pwede nang mag-maligo Pwede nang mag-maligo Ligo ka ba talaga kagad or okay lang bang medyo hindi muna ganun po Pwede nang mag-maligo Pwede nang mag-maligo Actually ako naging paranoid because of COVID kaya talaga basta lumabas ako I have to do that hindi na yung mawawala ngayon masalun mo Sorry, Dr. Shelly na tatawa Yes ma'am Go ahead ma'am Shelly, go ahead po Importante man talaga yung hygiene kasi kuminsan may umubo pala sa likod mo hindi mo alaman nakakapit sa buk mo So yes, minakaminimong siguro is when you get home you handle your mask properly and if you can wash it wag mo muna kung ayamong itapon there are some instances when you can wash your mask and wash your hands definitely change your clothes as much as possible that's the best way really to deal with the current situation pero we have data that hindi na masyado yung fomites yung sinasabi lang fomites yung dumidikit sa mga barot hindi na daw masyado yung pero dependerin sa baryente baka may variant na lumabas na So magingat na lang Anyway, mahilig naman tayong mga Pilipino na maligo kahit two times a day Lalo na ngayon tag-init Speaking of tag-init, very practical question kasi dati mga seniors isa sa mga simple join nila yung manuod ng cine ng lipre So in general what's our advice about watching movies na ko hindi ba, hindi pa yung masyado allowed sa I think, sa alert level one there are some facilities and establishments that really cannot open the same way that they did before the pandemic and movie theaters in the list di ba So para yung kasing gusto mga seniors di ba kasi malamig O malamig at siya kami-discount at libre Sige Reymod, baka may question ka pa? Question coming in from Roselle Tuvera she wants to ask if has there been any study or evidence comparing the immunity level nang hindi pa nagpabakuna pero nag-recover po sa COVID versus hindi pa po nagkakovid pero nagpabakuna na kung the elderly po meron po bang one have better immunity over the other um I will let to answer that it depends on the person kasi ang immune response to a natural infection will also depend sa kanyang general health status as even do sa vaccine in those immunity so hindi natin mag-generalize yan so ang importante siguro maintiliyan kung dinyo ay generally healthy nag-recover ang isa pa yan ay ang nakuhaban ang infection ay mild, moderate, or severe kapag mild lang kasi mababa relatively ang immune response versus dun sa nag-severe na nag-recover so kailangan tingnan isa isa I have an interesting question here from one of our one of our viewers na what do you do about organized anti-vaxxers in the community how should you I have a personal answer to that our panel how do we handle these anti-vaxxers sige anybody anybody can start lalo na yung they are trying to convince others not to be vaccinated I think Dr. Ed has an answer Dr. Sousy okay we have a lot of those experiences sa anti-vaxxers we even had a patient anti-vaxxer na kasi severe COVID na okay so during that that illness the first of the illness papapakunan ako ako naman teka ako pagalin muna kayo okay so after 4 million and 2 days and 2 weeks tinan nung ka na sige I'm going to schedule you hindi ay ako na hong hindi na ako so sabi kaya masap ka 4 million ano the most important thing I asked was why I think even in the patients in the clinics important thing there and the first thing you should know is why and you will see na napakavarid nung ka nila nang ka nila mga reasons mayro mga reasons sa nila magiging zombie ako by April 2022 ay nakapapakunan ako sabi kong lumahan na huyan kasi 2019 panamin na rinirigyan nang magiging zombie ka sana wala na yung nag-oflag na yun plus mayro na mag-just sabi na kasi ano yan well it is parang it's made in U.S.A. and decide to control people in the future marami mayro mga conspiracy theories na mga pinapalap kaya I think there is credence to the study I mentioned earlier about vaccine hesitancy being highest among the rich people people in the higher income status have more hesitancy kasi they have access to a lot of information whether good or bad pero malaman they also have a richer imagination as rich as their pockets so that they can even think about aliens alien invasion conspiracy theories yung magkakarok magiging zombie andami nilang langan dahilan but I don't find anything as sensible as I simply don't want it because kamokasis thinks na I want to exercise my right to refuse wala akong nariririg na ganoon na even at that patient na mga well-placed sa atili po na justices of high courts mga retired generals they have this wild wild reasons kung bakit so I think there should be a follow-up to this study and ask the question why lago na sa Filipinos kasi I think that would be quite fun and very very interesting siguro para sa atin so you I think the most important thing is why yeah nice Shelley with you Susie, iba yung vaccine hesitant sa vaccine anti-vaccine anti-vaccine okay, iba yun e we need to target these vaccine hesitant groups because they are still and they are the people who need information so let's build trust with them talk to them about safety processes how vaccines were developed how vaccine safety is assured including communicating with the healthcare sector because there are physicians who really do not recommend vaccines to their patients maybe some would recommend it to a specific age group about older people here but once a patient is already in their 90s ayunanila but they would agree that those in their 80s can still be vaccinated so we need to educate even the healthcare sector about safety, communicate vaccine safety to them and then of course talk to community and religious political leaders ang batikan came out with a communication brochure on how to talk to communities health religious communities about the safety of vaccination and that was quite helpful because there were some religious people who were talking about who were anti-vaxxers while they were giving their sermons in the pulpit in certain communities here in the Philippines so let's approach these leaders political community leaders on vaccine matters in the conversation but let's also remember that there is a historical basis maybe for their hesitancy some would say it's because of the deng-vax but remember that elderly of today probably did not have childhood vaccines so they had never experienced getting childhood vaccination yun yung mga 80-year-olds natin 90-year-olds so they had no experience of getting vaccinated and maybe when they were raising their children they also did not have that experience of sending their children who are now maybe in their 60s to get vaccinated so yun yung mga parang background that we need to understand so very important now is to really get the young, the mothers and even their grandchildren even involved in childhood vaccination because these young children will have that experience of having benefited from childhood vaccines and eventually as they become adults be more open to adult vaccination and even vaccination against the pandemic related viruses you're not going to take that you have to really counteract the misinformation with constant information constant accurate evidence-based information mamina, I'm sure this is the bane of your existence in the expert panel mga anti-vaxxer, what do you think how should we get them how should we deal with the anti-vaxxer especially those who try to convince others actually kami ay science-based yun naman ang kami communication parate but we need the help of the social scientists kasi mas magaling sila mag-explain and alam nila pa paano puntahan to mga hesitancy pero we're always going back to being science-based so we have to to give them, provide them the data kaya we continuously monitor what's going on so yun lang siguro pero do sa iba kailangan namin ang social scientists mas communication experts especially for me there are certain people who really fall easily into this conspiracy theory yes, to talk to yun parang they're really kait na anong situation yun ang default na yung very irrational so anyway so Doc Alvin si Doc Alvin kailangan nila mga gusto magsalita siya, anong tingin nyo ang anti-vaxxer no, there are groups kasi other doctors who believe napat daw hindi external yung treatment na binibigay napat daw yung strength of the body should come from within and it is we have to develop the immune system of our body without getting the vaccines because that has been shown in some of the experiences of others when the vaccines are still not around pag malakas yung katawan mo malakas ka inside hindi mo na kailangan ng vaccines so yun ang paniniwala nila parang ganoon so ang quite ko lang is that may logic na man e pero pwede naman siguro natin from within and from without yung bibigay na strength sa tao I agree I think that's correct in the context of an epidemic or a pandemic you have a highly transmissible microbe maparang ang the ads are the ads are you're gonna get it anyway okay Raymond question naman po well how important director de la vega so elderly when you reach a certain age you really are dependent on your schedule on your norms, on your ritual but because of the pandemic big lang na help yun sa bahay ka la so how important is it for the elderly to maintain that ritual even if na sa bahay pa lang po with regards to talking to their friends et cetera man it's very important for mental health very important especially for those with dementia that they stick to a schedule because it gets very confusing for them they forget where they are what time it is na meron akong paciente na akala niya na sa america pa siya kasi hindi siya lumalapas ang bahay so so what you really need to do especially for those with dementia is to keep a schedule na for them it also calms them by the way but for those without dementia it's very good for your mental health to keep a schedule even for us to still work when it's time for work I dress up as if I were going to work and it helps me think about being serious about what I'm going to do for that day and then of course meal time should always be preserved exercise time time for prayer and meditation very important so continue that very good for mental health most importantly to get in touch with family and friends okay so Raymond I'm mindful of the time and I know our speakers would like to to have a few more minutes in their parting messages but do you have any other maybe we can take one more question oh okay so which one should be good well mostly are anti-vaxxers and vaccine hesitant hesitant people and a little anecdotal sharing so I think this question very important although it's medyo na pahaggingan na rin po ito what about obviously we're talking about seniors just going out of the house and then going back to their house after grocery et cetera what about travel po ba is it okay for the elderly to travel whether it's by boat by bus or by plane what's the advice of the VEP well actually under alert level nung sang araw lang I had to answer that question yung dahil sa ayatarul na at least ng mask yes ma'am then I had to dig up researches or data especially airlines na yung pala sa plan o especially ang airflow ay maganda na si simulate yung parang nakadistancing ka but of course kahit magkatabi kayo di ba kinuna nila ng data ng simulation and actual data yung iba na mayroon palang ganon yung airflow na pababa na direction nang binya bababad apos lahat ng tao isang direction lang ang tingin but of course important ire na mayroong mask pero tinignan din nila na yung naka mask at di naka mask better talaga yung reduction in possible infection kung naka mask so siguro right now I'm going to travel soon medyo confident naman ako masan ham dun yung mga bakunado kayo better kung nakatatlo then you wear your PPE properly tapos hindi natin maano yung length of time pero siguro for the L daily wag muna yung masyadong mahahabang flights and it's not just inside that you can get the infection puwede rin kasi outside so you have to be conscious on that para sa aking I think that's a good point actually the airplane might be okay pero yung pagpila yung siksikan especially elections are coming I don't know people will have to be traveling to the precincts etc anyway siga so we are going to ask our panelists a couple of minutes to think about their parting message for our frontliners who are watching us today and meanwhile Raymond is going to go through the answers to our poll yes so the first question obviously I'll be calling din Nina na question po and this just for everyone's benefit din po reads ilang porcento ng senior citizens ang nabakonahan is it 84 percent 74 percent or 64 percent mam Nina al sagod yung kasi 74 yan yung march to data natin and siguro I also of course heard doctor ed na mayo siyang 60 to 63 actually depend yun sa denominator yung target population kaya mayo na iiba but that was from the rest bakuna data so we used 74 percent ayun okay before we go to that Raymond so I'm going to ask doc Nina so what do we want it to be what should be the what should be the coverage because we are targeting something na break wall na ang lahat sana na pwede na eligible ay magkarunan bakuna kasi nga in din natin alam kailan dadating mag-emphasya naman variant and so on we want that solid barrier to the virus sana hopefully 100 percent actually pero baka mahirap then we can lower it pero we have to aim higher okay thank you so very important kasi nga mapapansin nyo po if you remember the table of din Nina the A2 population and then the A3 yung pumpidiatric yung puyo talagang mabababa po na kailangan po yung target po na and that's why we have been having the national vaccination days part four na ngayon today puyata ang last day of that part four for the second question ano ang ibig sabihin nung term na healthy aging ano po ba mam shelly? kaya panggawin ang mahalaga sa kanila yun ang kamang sagatyan functionality functional well-being ayun thank you so much ano po siya at least in zoom 57 percent of those who participated chose that as their top answer po although there were still others who chose the other questions so I think we'll be moving on to what it calls the final messages po of our panelists unless you still need a bit more time okay okay na okay okay so ako na ba magsasalita yes older persons may safely go out in level one areas whether they're frail free frail or especially if they're robust but it's even safest it's safest for them to go out as soon as they have completed their vaccination and booster doses di ba and we need to make sure that we are able to sustain functional ability or healthy aging during this pandemic let's not lose focus ang gusto natin talaga is some things that are meaningful to us di ba bakit pa tayo magpapabakuna di ba and in order for us to achieve that we have to have a good health system and the community needs to be supportive social support, protection from ages and continue to learn and we go out because we want to walk out and be active so let's also have some enabling technologies and a good environment in order for our senior citizens to do all the things that are meaningful to them. Thank you. Okay, thank you very much. Dr. Alvin. Yes, we have to keep ourselves vigilant and keep ourselves updated and follow minimum protocols so that we try to update ourselves regularly so that we make informed decisions. Thank you. Okay, thank you very much. Dr. Poblete. Dr. Ed. Okay. Go ahead, sir. For seniors to be able to go out freely we have to trust our health care systems as well as our health care workers I believe that we are trying the utmost we have the utmost care for our patients and we won't put any one of them in harm, albeit we will be working towards a healthy aging system in the long run so sana po magtewala tayo na mas lubo sa kanila Thank you. Thank you very much, Dr. Poblete. Let's go to mom Nima. Yes, of course, I will do other panelists who know how to do or taking care of elderly me because of the vaccine I will be vaccinated to those who are not yet given a dose and if you have one and it will take a long time you can still get vaccinated and get a third dose yung iba po magkakaroonan ng second dose na second booster I mean, or fourth dose so tignan natin, mas makakalabas kayo mas magiging free kayo and mobile yon lang po, dala mat Thank you very much, Nina. Okay, so we are now going to go into our evaluation Yes, okay. Thank you, Dr. Sussi. So we still have well, a little over 1,000 participants in the Zoom So, uliting ko lang po, wala po kami inilalabas na hiwalain, evaluation poll eto lang po talaga yung evaluation poll namin and this is a four point Lycord scale na for five questions that we have and for these five questions these are as follows the panelists demonstrated thorough knowledge of the topic Number two, the panelists were well prepared and organized. Number three, the panelists spoke clearly and audibly. Number four, the panelists used appropriate language with technical medical jargon adequately explained. And number five, the panelists contributed to new perspectives and knowledge on managing virus-key COVID-19 health issues. So, strongly agree po yung satasa, so strongly disagree po yung nasa bababa. Yung iba po kasi ma, minsan daw po nalili ito we will not be closing for evaluation poll we are seeing that marami parin po ang sumasagot as Dr. Suzy introduces our synthesis and closing remarks speaker. Okay, for closing remarks today we have our deputy director for the Philippine General Hospital deputy director for health operations Dr. Stella Marie Jose Stella Hello everyone this is a very enlightening webinar as usual and all our speakers are experts in their field to summarize Dr. Shelly de la Vega reviewed the COVID-19 risk and morbidities for Filipino older people and she said that mortality is increased in 50 years old and above patients. She also said mentioned the special COVID population that the patients had dementia and the spectrum of our elderly population have the robust, the pre-failed frail and the frail and she emphasized the functional ability which is the intrinsic capacity of a person and sustained by environmental support She said that the healthy body through vaccination is very important and she cited three patients of hers who had the question on vaccination and the vaccinating, the vulnerable like the elderly is an absolute priority so the elderly in our audience we will follow Dr. Shelly because it is a very sensible recommendation she said if you can you should be a house to house to vaccinate that was also mentioned by Dr. Kobliate She also emphasized na merong manual, geraptic training for primary health primary health service service providers and dapad siguro tig na natin masahing natin to manual na ito She mentioned about digital connectivity of senior citizens na kakastimulate neuron para makatulung huyan sa senior citizens 83% now mostly use the cell phone 58% the laptop and 37% the desktop in a study in utilas banyos and utiliman ang kanyang at parting birds in how to prevent dementia is number one minimize diabetes mellitus with hypertension and minimize obesity napat lahat tayo mag take ng ating BMI ating body mass index at kana tayong lahat ay nandun sa normal range and she said that to achieve healthy aging do this to achieve healthy aging and quality of life sa talk ko ni Dr. Professor Nina Gloriani she mentioned yung topic natin talaga yung pwede bang lumabas ang mga senior citizens ang sabi niya you have to ask this question how safe is it so you have to do risk assessment tanaming din yung vaccination level of the senior citizens are they fully vaccinated or unvaccinated in the census of the Department of Health ang senior citizens ang fully vaccinated lang at unvaccinated ay 36% so madami pa rin unvaccinated for the unvaccinated are they at risk ang sagut po ay yes they are at risk kaya ko di sila lumalabas because family members are the ones who go out so the unvaccinated who get COVID for a longer period of time so may mention yung Omicron sub-variant yung original and other co-variants are more transmissible they cause severe disease and they evade the vaccine in use in immunity so take that into consideration so the considerations for senior citizens to be out are number one the vaccination status number two the risk assessment and vulnerability and you scan the environment and the activities to engage in ano ba ang predinin ang gawing activities and you have to wear the protective gear or the PPE so dapat improve natin ang ating national vaccination coverage per individual so the importance of vaccination is it is a protection for the elderly the boosters are added protection so hindi tayo dapat making complacent sa primary series lang at ngayon magkakarung padaw ng bali third dose tapos ang primary and booster magkakarung patayon ng another booster dose 9.7 million Filipinos receive the booster dose so magaba ko additional booster dose you have retained protection against the Omicron especially the VA.2 and we have to wear a fitted mask and so the last speaker Dr. Ed Publifer who is the president of the Philippine College of Geriatric Medicine emphasize about vaccine hesitancy so nakita nila na higher educated persons they are less hesitant siguro dahil na enlighten ang main sila sa lahat na mga webinars at siyang potions about this ang environmental factor ang indigent population they are less likely to be vaccinated age is a factor naging increase ang vaccine hesitancy and the socio-economic status also so the higher socio-economic status and surprisingly the more vaccine hesitancy ang suggestion of Dr. Ed Publifer is target vaccination and good education increase access more services for vaccination at sabi nga nirerecomend nga magkaroon ang senior citizen so magkaroon tayo ng vaccination days only for senior citizens and so with this one we hope to improve our vaccination statistics over to you Susie okay thank you so much Stella for that excellent summary we're so fortunate to have Stella with us today to do that summary marani salamat na okay so our discussion we'd like to thank all our panelists for the time that you spent with us you can see in the chat our audience really appreciates very much your your insights, sharing information and the personal sort of the personal experiences that you have shared with us marani salamat ko next week okay okay so we talked about ghera, I remember pinagusapan natin yung ghera ghera sa pandemya and through enough we're actually increasing COVID in other parts of the world but that's not what we're going to talk about we're going to talk about something that is not talked about very much but we think all health workers could benefit from learning more about chemical weapons nuclear nuclear attacks biological weapons radiation na hindi natin masyadong pinag-aaralan kasi wala namang need pero ngayon I'm sure many of you are following what's happening in Ukraine and itong giri ano between Russia and the western countries but an actual war in Ukraine where actually some banned weapons are being used merong mga ginagawa yung mga rasyan na kontra talaga sa sa international law so to prepare so that we have more information we are going to talk about how prepared are we for what should I say how do you call it chemical, biological nuclear weapons how prepared are we just in case so we are far away from Ukraine but we are not far away from North Korea or from China or from some other countries where there could be conflict so we are going to devote the next episode to talking about these new kinds of public health emergencies we are going to have experts from the Philippine General Hospital who will be talking about what we call CBRNE chemical, biological, radiation and nuclear events and what we should know what should we know I was in Japan for a while I was in Japan for three years may drill yan e for air raid merong threat ng nuclear weapon they know what they are going to do meron silang mga nilalagay sa ulo kung pupunta sila sa ilalim ng mesa nakadikit yung kamay nilang ganon kasi na dahanan na nilayon I'm not saying that that's going to happen to us but what I am saying is that because it's being discussed we should know as frontline health workers what this means but we should know and we should know more than what other people know so we are going to talk about that next week abangan nyo very very exciting discussion ko yan okay Raymond over to you Thank you Dr. Susie hindi lang po nasabi ni Dr. Susie pero matutua po kayo sa inibitahan at sana po ay makasama po siya at least for our webinar for next week really that at least in our opinion the top expert in this area po who will be discussing everything that's in relation to CBRN events po we are seeing on the screen po the results of our evaluation po we are happy to note that wala na po siyang problema with regards to the evaluation 685 or 69% of the participants were able to put in their answers po and at least well on average po 85% of those 85-80% answered strongly agree sa ating questions for the evaluation po so maraming maraming salamat po before we conclude our program we would like to acknowledge the very hardworking team behind the stop COVID-19 webinar series without each and every one of you we won't be able to churn out our quality content for our growing online credible online community po so maraming maraming salamat po sa lahat and finally all stop COVID-19 webinars are archived for viewing if you go to www.youtube.com forward slash tvupph I saw at least in the chat one question panodaw po niya mapapanod po ito dahil medyo intermittent na kanyang signal after this webinar kasaba po ng 91 webinars before it may isama po siya dito sa tvup youtube channel so punta lang po kay sa youtube go to tvup and you'll be able to see today's webinar archive there so this formally closes our webinar for this week, sa lahat po maray po kayo na tutunan something that could also be helpful and relatable, sa lahat po may share niyo rin po ang webinar po sa inyong mga elderly or senior citizens po na kaibigan, kamaganak magulang lo-lo-lo-lo-la po ninyo o ko-trabaho, mga katulong po ito para mas malinawan po siya sa pagbabakuna kano po ba yung kailangan po nilang gawin lalo na po nag alert level 1 sa maraming mga lugar we look forward to your company next week which is friday from 12 noon to 2 pm it's a date together we can stop COVID deaths so keep safe, keep healthy and see you next time do I have strength to carry on my God, our Lord, must this go on and leave you here to keep me strong I'm here to hold the line I'll keep my hand until my hand just hold on to the word he gave this time we'll come to pass because this salvation makes a last you'll carry you to see the break-up the others pained from my fears the others lashed before my tears but right behind the last I look into myself and ask do I have strength to carry on my God, our Lord, must this go on he's strong, I'm here to hold the line I'll keep my hand until my hand just hold on to the word he gave this time we'll come to pass because this salvation makes a last you'll carry you to see the break-up the others lashed before my tears but right behind the last I look into myself and ask do I have strength to carry you here to keep me strong I'll keep my pain before my tears