Ask the Experts: Men & Covid-19; Alcohol & Brain Function; “Welcome to Medicare” Visit
Q: Is it true that men are more likely than women to die from covid-19? If so, why is this?
A: Research does suggest that men are more likely to develop severe covid-19, and more likely to die from the virus. Researchers believe that the immune response may play a role in men’s heightened covid-19 susceptibility. A Yale study published in Nature, Aug. 26, identified differences in how the immune systems of women and men respond to SARS-CoV-2, which is the virus that causes covid-19. In the study, men had higher levels of cytokines: inflammatory proteins that help the body combat invading pathogens. These higher levels may cause what has been referred to as a “cytokine storm.” A cytokine storm can result in fluid building up in the lungs, depriving the body of oxygen and leading to organ failure. Conversely, women in the study had higher levels of T-cells. T-cells are white blood cells that eliminate pathogens. Researchers from the University of Washington have expanded on these findings (PLOS Biology, Sept. 8) with data indicating that in men, T-cells were not activated until three days after infection with covid-19.
It’s possible these data might help doctors identify who is more likely to be seriously affected by covid-19, and develop therapies that specifically target this apparent immune system disparity in men. But women are by no means immune to poor outcomes and death from the virus. As long as covid-19 persists, it is vital for both men and women to follow expert recommendations for staying safe.
Rosanne M. Leipzig, MD, PhD
Geriatric Medicine
Q: I’m not really a drinker, but I’ve heard that alcohol helps boost brain power in older adults. Should I consume it more often?
A: Studies have suggested that light-to-moderate alcohol consumption (red wine in particular) may help preserve heart health and brain function in older age. You may have seen media reports on a recent large study focusing on alcohol’s possible brain benefits. Compared to nondrinkers, study participants who had a drink or two per day performed better on cognitive tests (for reasons that are unclear, the benefit was not seen among African Americans). However, the data don’t prove a causal link between better cognition and alcohol consumption, and the researchers have emphasized that the results shouldn’t be seen as a reason to drink alcohol to prevent cognitive decline. Numerous studies have linked alcohol consumption to health harms in seniors—for example, it can raise the risk of falls and interacts with many drugs commonly taken by the old, and overdoing it can result in serious conditions like high blood pressure, stroke, and liver disease. If you’re not a regular drinker, I recommend you don’t increase your alcohol intake. Older adults who do regularly consume alcohol are advised to keep to no more than one standard drink per day. The latter equates to 12 ounces of beer or ale; 1.5 ounces of hard liquor; 5 ounces of wine; and 5 ounces of sherry, liqueur, or aperitif.
Sam Gandy, MD, PhD
Neurology
Q: I’ve been told I need to schedule a “Welcome to Medicare” visit. What does this entail?
A: Medicare covers a “Welcome to Medicare” visit within 12 months of signing up for Medicare Part B. (There is no Welcome to Medicare visit for people who opt to enroll in Part A only when they first become eligible for Medicare coverage.) The Welcome visit happens just once, and includes basic health checks like those performed in a routine annual physical (note that Medicare also covers the latter, which are termed “annual wellness checks”—we’ll be looking at these in an upcoming issue). Your doctor also will provide information about vaccinations and health screenings for older adults, and may discuss establishing an advance care plan to document the kind of care you want to receive at the end of your life. The Welcome to Medicare visit is free as long as your doctor accepts Medicare, and there is no deductible as long as your doctor does not perform additional tests that aren’t covered by Part B. For more information, visit the Medicare website (www.medicare.gov).
Sheila Barton, LCSW
Social Work
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