Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.
Featured topic and speakers
In today’s COVID-19 update, AMA Chief Experience Officer Todd Unger and AMA Chief Health and Science Officer Mira Irons, MD, take a look at the numbers, trends and latest news about COVID-19, including the possibility of a downward trend in new cases.
Learn more at the AMA COVID-19 resource center.
Speakers
- Mira Irons, MD, chief health and science officer, AMA
Transcript
Unger: Hello, this is the American Medical Association's COVID-19 update. Today we're taking our weekly look at the numbers, trends and latest news about COVID-19 with AMA's Chief Health and Science Officer, Dr. Mira Irons in Chicago. I'm Todd Unger, AMA's chief experience officer in Chicago.
Dr. Irons, let's start by reviewing this week's numbers. It looks like some differences in the trends. What's happening in the country with new cases and deaths?
Dr. Irons: Sure. So Todd, it looks as though we did hit that six million mark. So the current numbers are 6,031,281 people have been diagnosed with COVID and 183,602 people have died. Compared to globally, we're still just about a quarter of global cases with more than 25 million cases globally. However, if you look at the numbers, we've talked about this over the last few weeks, we were at 70,000 a day seven day averages, and then we went to 50,000, and then for the last two weeks, we were holding in that sort of 42,500 range.
It looks as though we might be starting a downward trend in new cases. It's always hard to tell whether that's real and will be sustained or whether that's a reporting artifact but we're starting to see a decrease in cases. But the other interesting thing, an important thing of note, is that we've talked about being on this plateau of 1,000 deaths per day, sadly, over the last really weeks. And Thursday and Friday reporting was that deaths were in the 900 range. I'm always careful about weekend reporting because those numbers are down. But yesterday, today we were less than 500. So certainly not ready to call anything, but things are starting to go down.
Unger: We're reaching those million case marks.
Dr. Irons: Yeah.
Unger: A little bit faster than we were before, is that right?
Dr. Irons: Oh, absolutely. When you look back, it took more than three months for the United States to reach its first million cases. And in this last period, it took less than a third of that time to notch the last million cases, 22 days. So it really tells the story of the surge.
Unger: U.S. still about a quarter of the 25 million cases globally?
Dr. Irons: Yes, yes, absolutely.
Unger: So let's talk a little bit about kind of what's underneath that. So state by state, are we seeing any kind of key trends?
Dr. Irons: We are. We're starting to see more cities, more businesses, more towns really trying to reinforce the masking information, that it's important to mask, it's important to socially distance and hand hygiene. But also we're starting to see some states and cities respond to the numbers and the things that are happening in their states. So Miami and New Jersey are reopening restaurants, indoor dining in limited capacity. California is going to begin to allow indoor dining to restart. They have a really interesting system that they're looking at. It's four tiered and it really depends on data. It's informed by data. The seven-day averages of new cases and they're going county by county. The large gatherings are still a concern. There's a report out of a cluster of cases in rural Maine that was limited to a wedding reception in early August that then spread to a county jail. So that's the important message.
Unger: Do you think that people are connecting the steps that we've taken in terms of wearing masks, washing hands, physical distancing are connected to this decrease that we're seeing out there?
Dr. Irons: I hope so. We know that it works. We know that wearing masks and socially distancing and hand hygiene works. I think that the businesses that have also reinforced the masking laws work, so that's the hope.
Unger: I know that I personally feel a lot more confident going into a Costco or a drug store.
Dr. Irons: Absolutely.
Unger: When I see everybody else masked up...it makes me feel like we're all in this together.
Well, let's talk about some of the other key trends that are happening this week. A big hurricane in Louisiana and Texas, let's talk about the impact there.
Dr. Irons: Oh, absolutely. The really devastating hurricanes that went through there. It's one thing to be trying to enforce masking and social distancing and then you have hundreds of thousands of people that have to leave their homes and seek shelter. So but what is I think really important is that listening to the authorities in Texas and Louisiana, they were actually talking about the fact that physical distancing was necessary. And they were trying to be aware of that as they were moving large populations of people. The same can be said in California with the fires last week. People were leaving their homes and seeking temporary shelter. And so that on top of a pandemic, it just adds to problems.
Unger: Well, one of the things that's on everybody's mind of course is back to school. And we've had a number of stories out there, especially about colleges. In fact, earlier this week, we talked with Dr. Brian Casey, the President of Colgate University about the steps that they're taking to bring students back to campus safely. What else are you hearing about in the world of colleges and their preparation for school?
Dr. Irons: So what's interesting, we're hearing a variety of things and the information is coming in real time, just as everything with this pandemic has occurred. And so there are many colleges that are sending kids home a week or two, and then there are a lot of cases on campus and they go home. Some colleges are quarantining or are switching to virtual instruction for 14 days. And others, still others, are doing what is being done at Colgate where the students are being tested frequently.
Colgate and also the University of Arizona are testing wastewater and that can give them a day or two notice potentially whether there are COVID cases in a dorm or in a small congregate living facility so that they can then go in, test the kids and isolate. I think I heard yesterday that the University of Arizona had a positive wastewater testing from one dorm. They went in and tested kids in the dorm. They had two positive cases. They isolated those kids and then they're able to contain the spread. Some colleges are hiring their own contact tracers so that they can actually enforce sort of the public health measures on the contact tracing on their campuses.
Unger: One of the things I know because my own daughter goes to Colgate University is just the appeal to students to be part of the solution and maintaining the ability to be on campus. Not seeing some other students in different places taking those same measures so a lot of breakouts at different universities, too. What are you seeing there?
Dr. Irons: Yeah, well Ohio State I think suspended 200 kids last week or around this time for large gathering. Some universities are actually limiting or eliminating large gap gatherings that are happening on university campuses. But some local bar owners are also taking the initiative and they're starting to see large numbers of kids come into bars without masks and they're actually closing down. So it's just an example of how it really takes a village. A university sits within a community and what happens in the community and the university affect each other.
Unger: How about teachers? What are we seeing? What steps are they taking in the absence of what are not always standardized safety guidelines?
Dr. Irons: Well, some teachers are adapting their classrooms on their own. They're creating barriers with plastic shower curtain, dividers, setting up wooden cubicles, socially distanced desks. And people are trying to take the guidance and make sure that it works for their settings to protect the kids and also to protect the staff.
Unger: Well, let's change a little subject, but there was some confusion and some push back and then a clarification last week from the CDC on their guidance. Can you talk about what happened and where we're at right now?
Dr. Irons: Oh, absolutely. So the CDC last week, and it became very public, revised their testing guidelines to exclude people who do not have symptoms of COVID-19. The new guidance really focused on symptomatic people and people who are in high risk categories. And there was immediate pushback from the AMA, but also other organizations. And the AMA's response was that months into this epidemic we know COVID-19 is spread by asymptomatic people. I mean we know that about 40% of the spread occurs through asymptomatic people. So that suggesting people without symptoms who have known exposure, who have been exposed to COVID positive individuals do not need testing is a recipe for community spread and more spikes in the coronavirus.
We have always from the beginning of this pandemic talked about evidence and the need for data to inform change. So the message that we sent was that when CDC updates a guidance, the agency should provide a rationale for that change. Tell us why the guidance changed. We weren't the only ones to question that. Two organizations that represent thousands of local public health departments asked for the guidance to be revised. Other experts pointed to the importance of identifying infections in the window immediately before the onset of symptoms. Dr. Redfield from the CDC did issue a statement saying that people with known exposures could get tested, but as far as I know, the guidance hasn't been officially revised.
Unger: I mean there is just no underestimating the need for clarity in communications. I know from looking at our own comments on Facebook from patients asking, in terms of wearing masks, "Does it matter if it's asymptomatic or symptomatic? We didn't have to wear masks in March, why do we have to wear them now?" These are really basic questions and it takes just constant clarity.
Dr. Irons: Yeah.
Unger: How do you achieve that?
Dr. Irons: Well, I think it's important to, you know evolution of knowledge is going to happen. It happens in science, it happens in medicine and I think this pandemic and this virus has specifically taught us things. We learn something new about it all the time. So that it is not surprising that people adapt guidance or change guidance, but what is really important is to provide a rationale for that change, to actually be transparent about the data that helped inform that change so that people can understand the changes.
Unger: Well, speaking of learning, there's always been big interest in what's the impact of having antibodies after you've had COVID-19 the first time? Can you get reinfected? What's the latest news there about what we're seeing?
Dr. Irons: Well, we're still learning, but we know a little more now than we did two weeks ago. Last week or the week before a gentleman in Hong Kong was reported as being reinfected with COVID-19. It was clear from testing that there were genetic differences in the strains from his first infection and his second infection so it was a reinfection. However, the important piece of that is that his second infection was asymptomatic. So it was in a sense much milder than his first infection, which is what you really want to see. If people do have antibodies, that they will be protected and have less of infection if they are reinfected.
There are some reports from Europe, I believe the Netherlands and Belgium, two case reports of the same type of thing happening. I haven't seen the details of that, but the reports are that the second infection was less. However, just a few days ago, I believe over the weekend, there was a Nevada gentleman who was reported as being reinfected. And the second infection was more severe so that he was hospitalized and had some lung changes. And so I think that we're still learning and I think the message is that if you have antibodies, and this is what we said, the AMA said in the guidance that we issued on serology going back a month or two, is that we don't know what protection having antibodies affords. And so from a personal standpoint, you should still protect yourself.
Unger: This is operating kind of like there are multiple strains of flu out there every year and you could get both. Is that how it works?
Dr. Irons: It's hard to tell right now, but I think that the level of immunity, how protected you are is one thing, but also whether there are changes that might make it more likely that you'll get a strain that has maybe been changed slightly.
Unger: Okay. So key thing, don't let your guard down.
Dr. Irons: Yeah.
Unger: Let's talk a move toward vaccines. There's some news lately about the development of vaccines and how quickly and the confidence that the American public has with that. So let's talk about that.
Dr. Irons: Yep, so in terms of the vaccine trials in the United States, there have been two phase three studies that have been going on now or have been recruiting since the end of July. One is the Moderna NIH trial, the other is the Pfizer trial. From the reports that we have, the goals for each trial are to recruit 30,000 people. What we've heard is that they're about half recruited.
But the important thing for those trials and any vaccine trials is that we really need the trials to include everyone, all of the different risk groups in the population. You want to make sure that you cover all ages, all races, all comorbidities, so that you can make a decision as to how effective the vaccine is in all of the different subpopulations.
A new trial started, another vaccine entered phase three trials in the United States just yesterday I believe and it's the Oxford UK vaccine. That vaccine has been in phase trials outside of the United States so we currently have three phase three trials going on in the United States today.
Unger: Do those numbers, in terms of the recruitment of people for those trials, do they seem slow, fast, on track? What would you say and what might be affecting the speed?
Dr. Irons: It's hard to say. I think that we're in the middle of a pandemic, so recruiting people is going to be harder. I think that there are concerns about what volunteering in a trial encompasses personally. So I actually look at those numbers as being good. I think we're trying to get as many people recruited as possible so that we can get an answer as to whether any or all of these vaccines are effective and whether they're effective in different populations. So I see that as a good thing.
Unger: Well, that's it for today's COVID-19 update. Dr. Irons, thanks so much for being here today and sharing your perspectives. We'll be back tomorrow with another COVID-19 update. For resources on COVID-19, visit ama-assn.org/COVID-19. Thanks for joining us today and please take care.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
