Featured topic and speakers
In today’s COVID-19 Update, a discussion with AMA's Director of Science, Medicine & Public Health, Andrea Garcia, JD, MPH, reviews COVID-19 vaccine numbers and trending topics related to the pandemic over the past week. Also covering global COVID-19 milestones, booster shots and more detail on "younger, sicker, quicker" phrase/trend.
Learn more at the AMA COVID-19 resource center.
Speaker
- Andrea Garcia, JD, MPH, director of science, medicine & public health, American Medical Association
Transcript
Unger: Hello, this is the American Medical Association's COVID-19 Update. Today we have our weekly look at the numbers, trends and latest news about COVID-19 with AMA's Director of Science, Medicine and Public Health Andrea Garcia in Chicago. I'm Todd Unger, AMA's chief experience officer also in Chicago.
Andrea, we're in the middle of a summer surge and it doesn't seem to be waning. Can you give us first an update on where we are standing with cases and deaths at this point?
Garcia: Yes, thanks, Todd. Appreciate the opportunity to be here. You're right, we are in the midst of a summer surge. There are about 35,950,379 reported cases of COVID and 617,424 deaths. For the first time since February, we're averaging in the U.S. more than 124,000 new cases per day. That's double the levels where we were two weeks ago and we're also averaging more than 60,000 hospitalizations per day. So, those infections and hospitalizations are increasing rapidly as the Delta variant spreads.
If you were to look at the CDC transmission map, today you would see almost every state is in that red and orange showing high or substantial transmission. So, meaning that the CDC's recommendation that everyone regardless of vaccination status should be wearing a mask in public indoor settings. I think the only exception at this point is Vermont and we know they have the best vaccination rate in the country.
Unger: Yeah, I saw that map this morning, and thus back here in Chicago we are wearing masks indoors. One thing that's interesting, just about the stats that I think I just wanted to get more detail about is kind of the deaths, in terms of the pace of those. I know that that is a lagging indicator obviously but it does seem to be moving, I guess, less in sync with what maybe we were used to at the end of last year. What's your perspective on that?
Garcia: Yeah, you're right, it's always been a lagging indicator. We always see the infections rise, the hospitalizations rise and that's followed by the deaths a couple weeks later usually. That does seem to be slower right now and we think that is because 80% of the U.S. population aged 65 and older, so that most vulnerable group, has been fully vaccinated. So, we think that is why we're not seeing the large increases in deaths at this point.
Unger: Another piece is around who's getting hospitalized at this point and we are seeing a trend of a lot more younger people. Let's talk a little bit more about what you're seeing there.
Garcia: Yeah, so we talked about how the older populations are largely protected, those younger populations are mostly unvaccinated at this point. So, we don't think that the rise in hospitalizations in this group is because the Delta variant is worse in young adults. We think this shift in patient demographic is really a result of lower vaccination rates in this group.
We're hearing from physicians working in the hot spots that the populations in their hospitals right now are not the populations that they saw last year. The populations they're seeing are almost always unvaccinated, they tend to be in their 20s and 30s and they seem to be sicker than patients who were in the hospital last year. So, they're deteriorating more rapidly. So we're hearing that phrase from physicians, "younger, sicker, quicker," as they describe who they're seeing in hospitals right now.
Unger: Younger, sicker, quicker. I follow a lot of AMA physicians on social media, I'm just seeing that story so consistently firsthand from physicians that remain on the front line. A lot of those are in the South and in Florida, other states like Texas. Any other kind of details on the hot spots that we're seeing right now?
Garcia: Yeah, you're absolutely right. The hot spots continue to be in the South. Louisiana is really leading the nation right now with new cases and the health care system there, like in other states, is overwhelmed. Florida, we talked about them last week, they continue to be in a dire situation. The state is averaging more than 19,000 new cases a day at this point, and Florida and Louisiana are both setting seven-day case records when it comes to cases.
So Florida, we're hearing the hospitalizations are really back at the peak to where they were last summer and Texas, too, we're hearing that the hospitals in Texas are really overwhelmed. We know that they're setting up field hospitals, they're talking about crisis standards of care. The situation in those health care systems in the South is particularly troubling, and on top of that, Florida, like Texas, they're prevented from issuing mask mandates by the governor's order, so they can't take those public health measures that we know would be so helpful right now.
Unger: That does seem to be in stark contradiction to the numbers that we're seeing in both of those states. Some states on the other hand are taking steps to put in mask mandates. Do you see the positive results from that?
Garcia: We're seeing some, and so we're seeing mask mandates a lot more on the local level. I think on the state level, it's really Louisiana, Hawaii, Washington, D.C., but cases in those hotspots earlier this summer, Missouri, Nevada, we were seeing surges there, those are starting to decline. We're seeing things starting to turn around there. We talked about the silver lining really being that this crisis is driving some of those hard hit areas to get more of their populations vaccinated.
Unger: So, what are we seeing with vaccinations this week? Do we see any uptick? People getting the message about how dangerous this Delta variant is?
Garcia: Yeah, so the pace of vaccination continues to inch upward very slowly. So we've talked about the last few weeks they've been slowly increasing throughout July into August. So we think this is partly fear of the situation we're seeing on the ground with the Delta variant but it's also due to an increase in mandates, that we're hearing more employers requiring their workers to be vaccinated. We're hearing about colleges mandating vaccinations for students returning to school.
So we're administering about 716,000 doses per day on average, that's up from 530,000 only a few weeks ago. The CDC's reporting about 195.2 million people who've reached at least one dose of COVID-19 vaccine. That's 58.8% of the population and 166.6 million, 50.2% who've been fully vaccinated. So, we finally last week reached that point with 50% of our population fully vaccinated.
Unger: We can give a big shout out to our own hometown here in Chicago, we passed the 70% mark for at least one shot. Then I believe that was among adults and I think the number is at 50% for 12 plus, 12- to 18-year-olds. So progress here and, again, on the local level variability there. Globally, we also passed a pretty terrible milestone this week. Can you tell us more about that?
Garcia: Yeah, the total global COVID cases surpassed the 200 million mark last Wednesday and it's a daunting figure and it's also likely an underestimate and it doesn't really begin to capture how much the virus has impacted the world. It took us a year to reach 100 million cases and now only six months later, we've reached that 200 million mark. We know the global death toll as of last Wednesday was about 4.25 million. Again, a serious underestimate just based on the way that we collect and report COVID deaths worldwide. We know 617,000 of those deaths were right here in the U.S.
Unger: How do you think vaccines have changed the way that we look at numbers like that, which are in scale extraordinary?
Garcia: I think it depends on the vaccination rate in the population. So in some places where you have a lot of vaccine, a lot of vaccinated population, that rise in cases is not going to be a predictor of hospitalizations or of the health care system being overwhelmed but where vaccines are scarce, that really doesn't remain changed. I mean, we really are still seeing that increase in cases, followed by increase in hospitalizations and deaths. So, we're obviously closely watching that link between vaccinations and case counts and that pressure on the health care system.
In other countries like Britain, for example, the situation I think is hopeful where you have nearly 75% of people over the age of 18 fully vaccinated. The virus there seems to, at least for the moment, be running out of fuel and they seem to be seeing a real decline in case counts.
Unger: Well, that dichotomy between countries with the vaccine and without is now playing out at another level as we start to see the demand and discussion around booster shots. Can you tell us more about that?
Garcia: Yeah, so Israel was one of the first countries to vaccinate the vast majority of their vulnerable residents, and we know that due to the number of breakthrough infections they're seeing in their vaccinated populations, they're going to start offering booster shots to everyone older than 60. Germany has also announced plans to offer booster shots to older residents and more vulnerable populations such as the immunocompromised.
I think we're hearing from the WHO, on Wednesday they called for a moratorium on booster shots at least until the end of September just to help get countries who don't have as much access to the vaccine, access to vaccinate 10% of their population before other countries with access move forward with these extra doses.
Unger: Well, despite that call for a moratorium, you can't open the paper, to use an old fashioned term, or read online anything right now, except for questions about boosters, when they're coming. What's the news here in the U.S. about that?
Garcia: So, we're definitely hearing in the news that FDA may be accelerating those efforts to authorize extra doses for COVID-19 vaccines for the immunocompromised specifically. We're hearing anecdotally that people are going to seek these out from vaccine providers. ACIP discussed vaccines in immunocompromised in late July. They're meeting again on Friday to talk about this. So we're expecting to see some sort of regulatory modification come as soon as this month and we think that would be a good step for getting that extra vaccine to those potentially vulnerable Americans.
I think we certainly need to weigh this decision in light of the WHO's requested moratorium. I think it can be frustrating for people who know that there are doses that are expiring and who really want that extra dose and want that protection, and I think the other thing to consider is that it's just not the immunocompromised who would benefit from this. We're seeing in the research that patients with weaker immune systems may give rise to more transmissible or ... variants, so that really could have a broader impact.
Unger: Absolutely. Well, one of the obstacles for some people who are remaining to be vaccinated has been around this issue of its approval. Right now, of course, we're under an EUA. There has been some news of late about when we might expect to see full approval of at least one of the vaccines. Any news on that?
Garcia: Yeah, so the FDA is aiming to give full approval to the Pfizer vaccine by early next month. They said in a statement that they recognize that this fall approval could inspire vaccine confidence in parts of the population, and so they're taking an all-hands-on-deck approach to get that approval done. Certainly we could see more vaccine mandates. We know some organizations are waiting for that BLA to be in place before moving forward with mandates.
Unger: Do you think that that had anything to do with the announcement this morning from the armed services about requirements for vaccines?
Garcia: It certainly could. I mean, I know that some are waiting for that BLA and getting certainly the military and getting our troops vaccinated is one population where that would be a step in the right direction.
Unger: Well, last question, any other messages from the AMA this week?
Garcia: Yeah, so the one thing I wanted to mention is the AMA and other health care organizations like the American Academy of Pediatrics filed an amicus brief that supports a public health law in D.C. It's called the District of Columbia's Minors Consent Act. It protects minors' access to medical care by allowing those minors who are capable of informed consent to obtain vaccines, such as those recommended by the Advisory Committee on Immunization Practices in specific circumstances.
So of course when physicians are treating minors, the standard is to involve parents in medical decision-making but we know that that's not always possible, it's not always practical and sometimes it's even harmful. With the Delta variant surging, kids going back to school, we think this law is really important and could ensure access to COVID vaccine for those kids age 12 and up who are currently eligible.
Unger: Well, thank you so much, Andrea, for this update, for your perspective. That's it for today's COVID-19 Update and we'll be back with another segment soon. In the meantime, for resources on COVID-19, visit ama-assn.org/COVID-19. Thanks for joining us, please take care.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
