Andrea Garcia, JD, MPH, discusses uptick in COVID cases & flu outbreaks [Podcast]

In today’s COVID-19 Update, a discussion with AMA's Director of Science, Medicine & Public Health, Andrea Garcia, JD, MPH, on COVID-19 vaccine numbers and trending topics related to the pandemic over the past week. Also covering the latest on COVID-19 treatment pills, expanding eligibility for booster shots, what the uptick in cases in Europe could forecast for the U.S., as well as flu outbreaks and press releases from the November 2021 Special Meeting of the AMA House of Delegates.

Learn more at the AMA COVID-19 resource center.

Speaker

• Andrea Garcia, JD, MPH, director of science, medicine & public health, American Medical Association

Unger: Hello. This is the American Medical Association's COVID-19 Update video and podcast. 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, it's going to be our last episode until Thanksgiving. The holiday is on everyone's mind right now. It's just next week. What are public officials, public health officials saying? If we're vaccinated, is this going to be a Turkey Day as normal?

Garcia: Well, thanks for having me back, Todd. And yeah, the consensus seems to be that people are not willing to give up another Thanksgiving. And since we now have ways to manage the virus, it becomes easier to lessen our risk than it was a year ago. I mean, first and foremost is obviously vaccination. If everyone you're gathering with who is eligible is vaccinated, and those who are vulnerable have received their booster, it becomes less risk, less risky to gather.

Now, even kids in the five to 11 age group can be partially protected. And for those who are still too young to get their shot, the best thing we can do is surround them with adults who are vaccinated. We know some people are also incorporating testing into their holiday plans, so having people take rapid tests the morning of or shortly before getting together.

Unger: Yeah. I went to a gathering a couple of weeks ago and we all took tests before we went. We're all vaccinated, which is good, so that sounds like a good procedure. And a lot of that seems like we're more and more into this assessing risk and making good decisions based on those assessments, not perfect but better than certainly where we were. How do we look at this?

Garcia: Yeah, I think that's exactly it. And Tara Parker-Pope, who's a writer for The New York Times, made a great analogy about risk calculation that I think captures really well and can help physicians who are trying to accurately communicate risk to patients. So she compared calculating our risk for COVID-19 to winter driving.

She said, "We know thousands of people are injured or killed each year on icy roads, but we don't stay home all winter. Right? We check the forecast. We look at whether roads have been plowed. We make sure our cars and tires are in good condition. We buckle our seat belts and we hit the road. And we go shopping for groceries or we go to school. We gather to see family for the holidays."

And this is how some experts see COVID playing out in the future. We'll look at local conditions, local transmission levels, take precautions to the extent that we can. And we'll live with some level of risk to avoid the cost of missing important time with family and friends.

Unger: Now, you mentioned just a little bit upfront about on the new treatment front. Let's talk specifically about the pills that are being developed and showing a lot of promise there. What are the details? Where does it stand right now?

Garcia: Yeah. So earlier this month, Pfizer reported that its antiviral pill to treat COVID was highly effective at preventing severe illness among at-risk people who received the drug soon after exhibiting symptoms. According to the company, the trial revealed that the pill cut risk of hospitalization or death by 89% when given within three days at the start of symptom onset. We know this is the second antiviral pill demonstrated, that's demonstrated a reduced risk of severe illness from COVID.

Merck's antiviral pill is also currently awaiting federal review and authorization. And so both of these pills once authorized will be able to be dispensed at pharmacies and taken at home, which will be an important tool to help us manage and treat COVID in the future.

Unger: Do we have any sense of the timing on that? Are we talking about months, weeks?

Garcia: So we know that the FDA is meeting on, to review the data on the Merck pill, on November 30. So we expect that one to go through that review and possible authorization first.

Unger: And of course, number one tool is vaccination.

Garcia: That's right.

Unger: Let's talk a little bit about where we stand with vaccinations this week.

Garcia: So according to the CDC this week, a total of 227.1 million Americans have received one dose. That's 68.4% of the total population. Of those, 195.3 million are fully vaccinated or 58.8% of the population. And we continue to see those numbers for booster doses go up. The CDC is estimating that 30.1 million people have received a booster dose.

Unger: And very interesting to see states starting to weigh in about expanding the eligibility for boosters. What are you seeing there?

Garcia: Yeah, so some states have begun encouraging all adults to get a booster shot, those include California, Colorado, New Mexico and Arizona. Most recently, New York City also expanded access, encouraging all who, all adults who want a booster to get one. And they're also asking health professionals to not turn them away, provided that it's been, of course, at least six months since their second shot of a Pfizer or Moderna vaccine, or at least two months since they've received a single dose Johnson & Johnson shot.

Last week, Pfizer did request that the FDA expand eligibility of its booster shot to all adults but the FDA has not yet weighed in with a decision on that.

Unger: So of course, the other big topic of the last couple of weeks has been around vaccine mandates. We had a great conversation with Dr. Bechara Choucair earlier this week. Any updates from your end about mandates?

Garcia: So the legal challenges around mandates continue, the most recent of which is happening in Florida, where lawmakers are kicking off a special legislative session to take up legislation aimed at restricting vaccine mandates. We know that several states, including Florida, have already challenged federal mandates in court.

And last week, the appeals court barred President Biden's vaccine mandate, the OSHA emergency temporary standard for large employees, saying it grossly exceeds the authority that OSHA has. However, it's unlikely that that's going to be the end of it, right? There are multiple challenges happening and the Supreme Court is expected to eventually decide the matter.

Unger: And I know over the weekend, the surgeon general also weighed in on efforts to block these mandates. What are the details there?

Garcia: On Sunday, Dr. Vivek Murthy said, "It would be a setback for public health if courts continued to block these mandates." He said that, "Mandates are well established and highly successful in achieving more widespread vaccination. We know schools, the military and workplaces such as hospitals have long required vaccines." He said, "The goal here is creation of a safer workplace for workers, for customers to increase vaccination rates overall because that's ultimately how we're going to end this pandemic."

Unger: And speaking of pandemic, still a lot of cases and hospitalizations. It looks like the declines that we were seeing have plateaued, maybe some upticks in different areas. What are we seeing across the nation here?

Garcia: Yeah. So according to The New York Times' data, COVID cases in the U.S. are starting to tick up again after plateauing at a high level following the Delta surge over the summer. As of Monday night, we were averaging about 85,000 cases a day for the past week, so that's a 14% increase from two weeks ago.

Reported deaths are still, are down 14%. Hospitalizations have decreased 7% but we know that those numbers lag behind cases. Conditions are slowly deteriorating in the West, the Upper Midwest and the Northeast. And some experts are warning that this could be the start of a possible winter surge.

Unger: That is not good news.

Garcia: No, it's not.

Unger: In addition to what we're seeing here in the States, also seeing some urgent information coming out of Europe where the cases are ticking up there, possibly a warning sign for us. How are they responding in Europe?

Garcia: Yeah. Europe has responded by toughening its rules for the unvaccinated, who officials say are driving another wave of infections. On Monday, we saw the Austrian government say that unvaccinated people over the age of 12 will need to restrict their movement to traveling for work, school, buying groceries and seeking medical care. New cases there have been ... They've doubled in the last two weeks. So across Europe really countries are passing rules to make life harder for the unvaccinated and this is obviously in hopes that those individuals will go get the vaccine.

Unger: It seems like we're just going to continue to have these kind of waves that go through and ripple through unvaccinated populations, very distressing. That's not the kind of winter I was hoping for. In addition to what we're seeing on the COVID-19 front, there's a lot of concern about people and getting their flu shots. What is the data telling us there?

Garcia: As of October 29, 158.7 million flu vaccine doses have been distributed in the United States. According to the CDC, that's concerning because that's down roughly 8% from the 172.3 million doses that hadn't been distributed at the same time last year. We know that we're seeing lower flu vaccination and that's I think troubling because we don't know what to expect this flu season.

Last year, what we saw was not normal. There was very little flu virus circulating last year. This year, people could have less immunity but we also have fewer public health mitigation measures in place for COVID. So we could definitely see a more severe flu. I think it's a really good reminder for physicians to continue to ask their patients and offer the flu vaccine. It is definitely not too late.

And I think we're also seeing some data that, it's important to remind patients that COVID vaccines do not protect against flu. You need both vaccines. Flu protects against flu. And COVID vaccine protects against COVID. So the last thing we want to do is overwhelm our already stressed health system, so we really need people to get both vaccines.

Unger: Absolutely. And now I've gotten my flu shot as did my family. It's a good thing because I think we're starting to see possible flu outbreaks across the country.

Garcia: Yeah. The CDC is looking into a flu outbreak at the University of Michigan. About 77% of the cases have occurred in individuals who did not get this year's flu vaccine. We know the campuses' first flu case was flagged on October 6. And since then, the University Health Service has diagnosed 528 additional people. That's according to The University Record, the university's new service.

Local health officials have said the size of this outbreak is unusual. And while it doesn't necessarily have an immediate impact on the broader community, I think it does raise concern as we have college kids potentially traveling home for the Thanksgiving holiday.

Unger: You said it, number one, get your flu shot. Finally, any last messages from the AMA this week that you want to share?

Garcia: Yes. Last week, the AMA once again came out in support of vaccine mandates, urging the U.S. Court of Appeals for the Fifth Circuit to preserve the emergency temporary standard for COVID-19 vaccination and testing as issued by OSHA.

"The AMA regards widespread vaccination as the most effective way to protect workers from COVID-19. We know that no other measures have been shown to reduce the risk of infection, hospitalization and death from COVID to the degree that vaccination does."

The AMA has also issued multiple press releases from the November 2021 Special Meeting of the AMA House of Delegates, which can be found on the AMA's website.

Unger: That's it for today's COVID-19 Update. Andrea, thanks so much for joining us today. We'll be back with another COVID-19 Update video and podcast on December 2. For resources on COVID-19 in the meantime, go to 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.